Extraarticular features in RA, EXCEPT:

• A. Generalized osteoporosis
• B. Vasculitis
• C. Amyloidosis
• D. Libman-Sacks endocarditis

Answer: (D)

The key idea is identifying what features can accompany rheumatoid arthritis outside the joints versus findings tied to other autoimmune diseases. Libman-Sacks endocarditis is a type of sterile vegetation on heart valves that is classically seen in systemic lupus erythematosus, especially with antiphospholipid syndrome. It is not a typical extraarticular manifestation of rheumatoid arthritis, so it stands out as not belonging to the RA spectrum.

In contrast, generalized osteoporosis can occur in RA due to chronic inflammation and long-term steroid use; vasculitis can occur as a serious systemic complication of RA; and secondary amyloidosis (AA) can develop from prolonged inflammatory activity in RA, leading to organ involvement such as renal amyloidosis. These are recognized extraarticular manifestations of RA, unlike Libman-Sacks endocarditis.