A 58-year-old man with seropositive rheumatoid arthritis presents with multiple firm, non-tender subcutaneous nodules over the extensor surface of the forearm. What is the most common extra-articular manifestation of rheumatoid arthritis?

• A Interstitial lung disease
• B Felty syndrome
• C Episcleritis
• D Rheumatoid nodules ✓

Explanation

Rheumatoid nodules are the most common extra-articular manifestation of RA, occurring in approximately 20-30% of seropositive patients. They typically appear over extensor surfaces and pressure points. Interstitial lung disease, episcleritis, and Felty syndrome (RA with splenomegaly and neutropenia) are recognized but less common extra-articular features.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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