In addition to synovitis, RA causes general ill health. Patients lack energy and often have systemic features of a 'flu-like' illness. These include loss of appetite, inability to sleep, weight loss and, in some case, a mild fever. The systemic features are most noticeable at the beginning of the disease, especially in cases with an 'explosive' onset. Generally, these features are seen in all chronic inflammatory diseases and it is likely that they represent the non-specific inflammatory response of innate immunity. A minority of patients, especially those who are rheumatoid factor positive may have extra-articular disease (see below), which can cause systemic disease.
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