Which feature of rheumatoid arthritis is associated with a poorer prognosis?

• A. Monarthritis
• B. Female sex
• C. Extra-articular involvement
• D. Early onset

Answer: (C)

Extra-articular involvement signals a more systemic and aggressive form of rheumatoid arthritis. When disease extends beyond the joints to include things like subcutaneous nodules, vasculitis, interstitial lung disease, pericarditis, or anemia of chronic disease, it reflects higher inflammatory burden and a greater risk of complications, leading to worse functional outcomes and higher mortality. That’s why this feature is linked to poorer prognosis.

Monarthritis often points to limited joint involvement, especially early on, so it doesn’t inherently imply a worse outcome. Female sex isn’t a reliable predictor of prognosis, and early onset RA can still respond well to early, aggressive treatment, so it isn’t inherently a poorer prognostic sign.