Editing Rheumatoid arthritis (section)

===Other===
The role of the circadian clock in rheumatoid arthritis suggests a correlation between an early morning rise in circulating levels of pro-inflammatory cytokines, such as [[interleukin-6]] and painful morning joint stiffness.<ref name="pmid23427807">{{cite journal | vauthors = Gibbs JE, Ray DW | title = The role of the circadian clock in rheumatoid arthritis | journal = Arthritis Res Ther | volume = 15 | issue = 1 | pages = 205 | date = February 2013 | pmid = 23427807 | pmc = 3672712 | doi = 10.1186/ar4146 | doi-access = free }}</ref>

==== Kidneys ====
Renal [[amyloidosis]] can occur as a consequence of untreated chronic inflammation.<ref>{{cite journal | vauthors = de Groot K | title = [Renal manifestations in rheumatic diseases] | journal = Der Internist | volume = 48 | issue = 8 | pages = 779–785 | date = August 2007 | pmid = 17571244 | doi = 10.1007/s00108-007-1887-9 | s2cid = 28781598 }}</ref> Treatment with [[penicillamine]] or [[gold salts]] such as [[sodium aurothiomalate]] are recognized causes of [[membranous nephropathy]].<ref>{{cite journal | vauthors = Moroni G, Ponticelli C | title = Secondary Membranous Nephropathy. A Narrative Review | journal = Frontiers in Medicine | year = 2020 | volume = 7 | pages = 611317 | pmid = 33344486 | doi = 10.3389/fmed.2020.611317 | pmc = 7744820 | doi-access = free }}</ref>

==== Eyes ====
The eye can be directly affected in the form of [[episcleritis]]<ref name=Schonberg>{{cite book | vauthors = Schonberg S, Stokkermans TJ | chapter = Episcleritis | date = January 2020 | pmid = 30521217 | url = http://www.ncbi.nlm.nih.gov/books/nbk534796/ | title = StatPearls | location = Treasure Island (FL) | publisher = StatPearls Publishing }}</ref> or [[scleritis]], which when severe can very rarely progress to perforating scleromalacia. Rather more common is the indirect effect of [[keratoconjunctivitis sicca]], which is a dryness of eyes and mouth caused by [[lymphocyte]] infiltration of [[lacrimal gland|lacrimal]] and [[salivary gland]]s. When severe, dryness of the cornea can lead to [[keratitis]] and loss of vision as well as being painful. Preventive treatment of severe dryness with measures such as [[nasolacrimal duct]] blockage is important.<ref>{{cite journal | vauthors = Dammacco R, Guerriero S, Alessio G, Dammacco F | title = Natural and iatrogenic ocular manifestations of rheumatoid arthritis: a systematic review | journal = International Ophthalmology | volume = 42 | issue = 2 | pages = 689–711 | date = February 2022 | pmid = 34802085 | pmc = 8882568 | doi = 10.1007/s10792-021-02058-8 }}</ref>

==== Liver ====
Liver problems in people with rheumatoid arthritis may be due to the underlying disease process or as a result of the medications used to treat the disease.<ref name="Selmi2011" /> A coexisting autoimmune liver disease, such as [[primary biliary cirrhosis]] or [[autoimmune hepatitis]] may also cause problems.<ref name="Selmi2011">{{cite journal | vauthors = Selmi C, De Santis M, Gershwin ME | title = Liver involvement in subjects with rheumatic disease | journal = Arthritis Research & Therapy | volume = 13 | issue = 3 | pages = 226 | date = June 2011 | pmid = 21722332 | pmc = 3218873 | doi = 10.1186/ar3319 | doi-access = free }}</ref>

==== Neurological ====
[[Peripheral neuropathy]] and [[mononeuritis multiplex]] may occur. The most common problem is [[carpal tunnel syndrome]] caused by compression of the median nerve by swelling around the wrist.<ref>{{Cite journal |last1=Chung |first1=Tae |last2=Prasad |first2=Kalpana |last3=Lloyd |first3=Thomas E. |date=2013-05-25 |title=Peripheral Neuropathy |journal=Neuroimaging Clinics of North America |language=en |volume=24 |issue=1 |pages=49–65 |doi=10.1016/j.nic.2013.03.023 |pmid=24210312 |pmc=4329247 |issn=1052-5149 }}</ref>

[[Rheumatoid disease of the spine]] can lead to [[myelopathy]].<ref>{{Cite journal |last1=Mukerji |first1=N. |last2=Todd |first2=N. V. |date=2011 |title=Cervical Myelopathy in Rheumatoid Arthritis |journal=[[Neurology Research International]] |language=en |volume=2011 |pages=1–7 |doi=10.1155/2011/153628 |doi-access=free |issn=2090-1852 |pmc=3238417 |pmid=22203899}}</ref><ref>{{Cite journal |last1=Janssen |first1=Insa |last2=Nouri |first2=Aria |last3=Tessitore |first3=Enrico |last4=Meyer |first4=Bernhard |date=2020-03-17 |title=Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature |journal=[[Journal of Clinical Medicine]] |language=en |volume=9 |issue=3 |pages=811 |doi=10.3390/jcm9030811 |doi-access=free |issn=2077-0383 |pmc=7141180 |pmid=32191997}}</ref> 
[[Atlanto-axial joint|Atlanto-axial]] [[subluxation]] can occur, owing to erosion of the [[odontoid process]] or [[transverse ligament]]s in the [[cervical spine]] connection to the skull. Such an erosion (>3mm) can give rise to [[vertebrae]] slipping over one another and compressing the spinal cord.<ref>{{Cite journal |last1=Yang |first1=Sun Y. |last2=Boniello |first2=Anthony J. |last3=Poorman |first3=Caroline E. |last4=Chang |first4=Andy L. |last5=Wang |first5=Shenglin |last6=Passias |first6=Peter G. |date=2014-05-22 |title=A Review of the Diagnosis and Treatment of Atlantoaxial Dislocations |journal=Global Spine Journal |language=en |volume=4 |issue=3 |pages=197–210 |doi=10.1055/s-0034-1376371 |issn=2192-5682 |pmc=4111952 |pmid=25083363}}</ref> Clumsiness is initially experienced, but without due care, this can progress to [[quadriplegia]] or even death.<ref>{{cite journal | vauthors = Wasserman BR, Moskovich R, Razi AE | title = Rheumatoid arthritis of the cervical spine--clinical considerations | journal = Bulletin of the NYU Hospital for Joint Diseases | volume = 69 | issue = 2 | pages = 136–148 | year = 2011 | pmid = 22035393 | url = http://hjdbulletin.org/files/archive/pdfs/222.pdf }}</ref>

[[Vertigo]] may be associated with rheumatoid arthritis via the following associations that can cause [[vertigo]]:
* [[Ménière's disease]]<ref name="pmid29287768">{{cite journal | last1=Caulley | first1=Lisa | last2=Quimby | first2=Alexandra | last3=Karsh | first3=Jacob | last4=Ahrari | first4=Azin | last5=Tse | first5=Darren | last6=Kontorinis | first6=Georgios | title=Autoimmune arthritis in Ménière's disease: A systematic review of the literature | journal=Seminars in Arthritis and Rheumatism | volume=48 | issue=1 | date=2018 | issn=1532-866X | pmid=29287768 | doi=10.1016/j.semarthrit.2017.11.008 | pages=141–147}}</ref><ref name="pmid22053211 ">{{cite journal | last1=Gazquez | first1=Irene | last2=Soto-Varela | first2=Andres | last3=Aran | first3=Ismael | last4=Santos | first4=Sofia | last5=Batuecas | first5=Angel | last6=Trinidad | first6=Gabriel | last7=Perez-Garrigues | first7=Herminio | last8=Gonzalez-Oller | first8=Carlos | last9=Acosta | first9=Lourdes | last10=Lopez-Escamez | first10=Jose A. | title=High prevalence of systemic autoimmune diseases in patients with Menière's disease | journal=PLOS ONE | volume=6 | issue=10 | date=2011 | issn=1932-6203 | pmid=22053211 | pmc=3203881 | doi=10.1371/journal.pone.0026759 | doi-access=free | page=e26759}}</ref>
* "Biologic disease-modifying antirheumatic drugs"<ref name="pmid29466539">{{cite journal | last=Roberts | first=Richard A. | title=Management of Recurrent Vestibular Neuritis in a Patient Treated for Rheumatoid Arthritis | journal=American Journal of Audiology | volume=27 | issue=1 | date=2018-03-08 | issn=1558-9137 | pmid=29466539 | doi=10.1044/2017_AJA-17-0090 | pages=19–24}}</ref> This may not happen in the absence of infection.<ref name="pmid24770796">{{cite journal | last1=Toktas | first1=H. | last2=Okur | first2=E. | last3=Dundar | first3=U. | last4=Dikici | first4=A. | last5=Kahveci | first5=O. K. | title=Infliximab has no apparent effect in the inner ear hearing function of patients with rheumatoid arthritis and ankylosing spondylitis | journal=Clinical Rheumatology | volume=33 | issue=10 | date=2014 | issn=1434-9949 | pmid=24770796 | doi=10.1007/s10067-014-2625-z | pages=1481–1487}}</ref>
* [[Atlanto-axial joint]] instability can cause symptoms including vertigo and sudden death.<ref name="pmid37841539">{{cite journal | last1=Subagio | first1=Eko Agus | last2=Wicaksono | first2=Pandu | last3=Faris | first3=Muhammad | last4=Bajamal | first4=Abdul Hafid | last5=Abdillah | first5=Diaz Syafrie | title=Diagnosis and Prevalence (1975-2010) of Sudden Death due to Atlantoaxial Subluxation in Cervical Rheumatoid Arthritis: A Literature Review | journal=TheScientificWorldJournal | volume=2023 | date=2023 | issn=1537-744X | pmid=37841539 | pmc=10569890 | doi=10.1155/2023/6675489 | doi-access=free | page=6675489}}</ref>
* Atypical Cogan's syndrome may be associated with rheumoatoid arthritis.<ref name="pmid24418297">{{cite journal | last1=Kessel | first1=Aharon | last2=Vadasz | first2=Zahava | last3=Toubi | first3=Elias | title=Cogan syndrome--pathogenesis, clinical variants and treatment approaches | journal=Autoimmunity Reviews | volume=13 | issue=4–5 | date=2014 | issn=1873-0183 | pmid=24418297 | doi=10.1016/j.autrev.2014.01.002 | pages=351–354}}</ref>

==== Constitutional symptoms ====
[[Constitutional symptoms]] including [[fatigue (medical)|fatigue]], low grade [[fever]], [[malaise]], [[morning stiffness]], [[loss of appetite]] and [[loss of weight]] are common systemic manifestations seen in people with active RA.

==== Bones ====
Local [[osteoporosis]] occurs in RA around inflamed joints. It is postulated to be partially caused by inflammatory [[cytokines]]. More general osteoporosis is probably contributed to by immobility, systemic cytokine effects, local cytokine release in bone marrow and corticosteroid therapy.<ref name="pmid16271143">{{cite journal | vauthors = Ginaldi L, Di Benedetto MC, De Martinis M | title = Osteoporosis, inflammation and ageing | journal = Immunity & Ageing | volume = 2 | issue = | pages = 14 | date = November 2005 | pmid = 16271143 | pmc = 1308846 | doi = 10.1186/1742-4933-2-14 | doi-access = free }}</ref><ref name="pmid25905202">{{cite book | vauthors = Ilias I, Milionis C, Zoumakis E | chapter = An Overview of Glucocorticoid-Induced Osteoporosis. | date = March 2022 | title = Endotext [Internet]. | location = South Dartmouth (MA) | publisher = MDText.com, Inc. | url = https://www.ncbi.nlm.nih.gov/sites/books/NBK278968/ | pmid = 25905202 | veditors = Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, New M, Purnell J, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, Ilias I, Milionis C, Zoumakis E | display-editors = 6 }}</ref>

==== Cancer ====
The incidence of [[lymphoma]] is increased, although it is uncommon and associated with the chronic inflammation, not the treatment of RA.<ref>{{cite journal | vauthors = Baecklund E, Iliadou A, Askling J, Ekbom A, Backlin C, Granath F, Catrina AI, Rosenquist R, Feltelius N, Sundström C, Klareskog L | title = Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis | journal = Arthritis and Rheumatism | volume = 54 | issue = 3 | pages = 692–701 | date = March 2006 | pmid = 16508929 | doi = 10.1002/art.21675 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Franklin J, Lunt M, Bunn D, Symmons D, Silman A | title = Incidence of lymphoma in a large primary care derived cohort of cases of inflammatory polyarthritis | journal = Annals of the Rheumatic Diseases | volume = 65 | issue = 5 | pages = 617–622 | date = May 2006 | pmid = 16249224 | pmc = 1798140 | doi = 10.1136/ard.2005.044784 }}</ref> The risk of [[non-melanoma skin cancer]] is increased in people with RA compared to the general population, an association possibly due to the use of [[immunosuppression]] agents for treating RA.<ref>{{cite journal | vauthors = Assassi S | title = Rheumatoid arthritis, TNF inhibitors, and non-melanoma skin cancer | journal = BMJ | volume = 352 | pages = i472 | date = January 2016 | pmid = 26822198 | doi = 10.1136/bmj.i472 | s2cid = 45857932 }}</ref>

==== Teeth ====
[[Periodontal disease|Periodontitis]] and tooth loss are common in people with rheumatoid arthritis.<ref name="pmid19337286">{{cite journal | vauthors = de Pablo P, Chapple IL, Buckley CD, Dietrich T | s2cid = 7173008 | title = Periodontitis in systemic rheumatic diseases | journal = Nature Reviews. Rheumatology | volume = 5 | issue = 4 | pages = 218–224 | date = April 2009 | pmid = 19337286 | doi = 10.1038/nrrheum.2009.28 }}</ref>