| Summary: | <b>Background and Objective: </b> The frequency of extra-articular manifestations in rheumatoid arthritis (ExRA) differs from one country to another, so we investigated ExRA frequency in a well-defined hospital patient popula--tion with rheumatoid arthritis (RA) in Saudi Arabia. We also examined possible predictors of the development ExRA. <b> Methods: </b> A retrospective analysis was conducted of all patients diagnosed with RA at a university hospital dur--ing a 4-year period. Cases were classified according to the 1987 American College of Rheumatology criteria for RA, and the frequency of ExRA was recorded. <b> Results: </b> Of 140 patients who fulfilled the criteria for the diagnosis of RA, 98 (70%) developed ExRA features. Anemia occurred in 61%, thrombocytosis in 16%, pulmonary involvement in 10%, and renal amyloidosis, vas--culitis and Felty syndrome were present in 6%, 2% and 1%, respectively. The mortality rate was high (16%) in patients with ExRA. The predictors for mortality were lung involvement, age over 50 years and kidney amyloidosis. <b> Conclusion: </b> ExRA were present in a substantial proportion of our patients, which lead to a worse disease outcome. Anemia, thrombocytosis and respiratory system involvement were the commonest. Early recognition and treatment are important to decrease mortality.
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