Rheumatoid arthritis (RA) is the most prevalent of the chronic inflammatory joint diseases, with gradual destruction of joints and an increased risk of co-morbidity, predominantly cardiovascular disease. Some patients develop extra-articular manifestations (ExRA), affecting other tissues and organ systems, distinct from the co-morbidities occurring in the same organ systems [1]. In addition to increased mortality due to cardiovascular or pulmonary co-morbidity [2-4] ExRA can explain the excess mortality rates [5,6,7].