Rheumatoid arthritis (RA) affects 1 percent to 2 percent of people worldwide. It is an autoimmune disease that occurs when the immune system mistakenly attacks the joints of the body. Although rheumatoid arthritis is well known for affecting the joints, it can also affect other parts of the body. Complications of RA that occur outside of the joints, called extra-articular manifestations, are most common in people with more severe joint disease.
Risk factors for extra-articular complications of RA include older age, having antibodies called rheumatoid factor (seropositive RA), early disability, and smoking.
If you are experiencing complications of RA, follow your rheumatologist’s medical advice to get the best care for your situation. Some complications associated with RA are more common than others, and many can be managed by staying active, maintaining a healthy weight, not smoking, and treating your RA. These complications include:
Joint damage is one of the major impacts of RA. Antibodies made by the immune system attack the joints, leading to inflammation of the tissue in the joint called the synovium. The joint tissue eventually wears away and contributes to breaking down the bones of the joint. Bone erosion can cause limited mobility and deformity in the joints.
|A closer look: managing symptoms and complications in RA|
Medication for RA can slow the immune response to protect the joints from the immune system attack. Common treatments include disease-modifying antirheumatic drugs (DMARDs) like Trexall (methotrexate), Azulfidine (sulfasalazine), and Arava (leflunomide), which limit disease activity. Other drugs, called biologics, may decrease the immune response and control inflammation. Biologics include Humira (adalimumab) and Orencia (abatacept). Joint pain can sometimes be controlled by taking nonsteroidal anti-inflammatory drugs (NSAIDs).
If RA is not controlled, progressive damage to the joints can make them very painful or nonfunctional. Joint replacement might be an option to restore function and reduce pain in the case of these complications.
Anemia, or a low level of red blood cells, is common in people with RA. Your body uses red blood cells to take oxygen to tissues throughout your body. The red blood cells use an iron-rich protein called hemoglobin to move oxygen. If your body does not have enough red blood cells or hemoglobin to move an adequate amount of oxygen, you may feel short of breath, dizzy, and weak.
People with RA might be more likely to have anemia because inflammation could affect the red blood cells, or because excessive use of NSAIDs can cause bleeding and blood loss in the stomach. One study of more than 2,000 people with RA showed that worse anemia corresponded to more physical disability with RA. This same study showed that effective treatment for RA increased the levels of hemoglobin and reduced anemia.
Lung complications are one of the most common symptoms of RA that do not involve the joints. People with RA are about eight times more likely to have lung disease than the general population. Lung problems include lung scarring, nodules (noncancerous lumps) that can rupture, inflammation of the lung tissue (pleural effusion), and airway obstruction.
Although it is a rare side effect, the DMARD called methotrexate is associated with lung injury in less than 1 percent of people. Methotrexate is not recommended for use by people with existing lung disease.
According to the Arthritis Foundation, people with RA are almost twice as likely to develop cardiovascular disease (heart disease) as people without RA.
The high levels of inflammation that happen in RA may lead to lower levels of lipids circulating in the body, including both “good” and “bad” cholesterol. These low levels of lipids are associated with an increased risk of heart disease, including heart attack, stroke, heart failure, hypertension (high blood pressure), and pericarditis (inflammation of heart tissue).
The risk of heart disease is even greater in people with obesity, so maintaining a healthy weight is also important. The Arthritis Foundation notes that you can limit your risk of heart disease by not smoking, eating healthy, staying active, and taking fewer NSAIDs, in addition to following treatment plans for your RA.
The loss of bone is called osteoporosis, and it is a common issue in people with RA. People with RA may have an increased risk of osteoporosis due to taking glucocorticoids (corticosteroids) for RA, which can lead to bone loss. Although high levels of steroids can lead to bone loss, taking lower levels of steroids seems to protect bones, possibly because of the anti-inflammatory effects.
RA may also contribute to osteoporosis risk. Inflammation around the joints can trigger the immune system to attack bones and lead to lower bone density. A higher risk of bone fracture is associated with an inflammatory protein called C-reactive protein (CRP).
People with RA may also be at greater risk of osteoporosis because the symptoms of RA can make physical activity difficult, and inactivity can lead to bone loss.
RA is associated with a modestly higher rate of lymphoma, a type of cancer that affects the lymphatic system (including the lymph nodes, spleen, thymus gland, and bone marrow). Although the risk of non-Hodgkin lymphoma (a type of lymphoma) is about 2 percent in the general population, it is increased to about 4 percent in people with RA.
Researchers used to worry that medications for RA increased the risk of lymphoma. However, a couple of studies have shown that people who take tumor necrosis factor inhibitors are not at an increased risk of lymphoma compared with people with RA who have not taken those medications.
Vasculitis is a rare complication that occurs in about 1 percent of people with RA. Rheumatoid vasculitis (RV) can cause swelling of the small- and medium-sized blood vessels, constricting blood flow to the skin, nerves, fingers, and toes. The lack of blood flow in the fingers and toes can cause tingling and numbness, and eventually, the tissue starts to die.
RV is typically diagnosed with a biopsy. Controlling the symptoms of RA can also help control RV. A corticosteroid used to treat RA (prednisone) and other immunosuppressive medication can also help treat vasculitis.
A tissue in the eyes similar to the tissue in the joints can also be attacked by the immune system in people with RA. This immune attack can lead to inflammation of tissues in the eyes, causing excessive dryness that can affect vision. Eye dryness is also a symptom of another autoimmune disease associated with RA called Sjӧgren’s syndrome. People with RA might need eyedrops, artificial tears, or ointment to keep their eyes moist.
Other issues include scleritis (inflammation of the white part of the eye), blockage of blood vessels in the eyes, glaucoma, and cataracts. According to the American College of Rheumatology, a DMARD used to treat RA, called hydroxychloroquine, can also cause eye problems in rare cases.
Scientists are not sure why RA increases the risk of diabetes, but it may be due to the level of inflammation involved in both diseases. Some studies show that higher levels of inflammation are associated with a higher risk of type 2 diabetes. Another study showed that the risk of diabetes in people with RA was lower in those taking medication to control inflammation.
The complications related to RA can generally be managed through the treatment of rheumatoid arthritis. The Centers for Disease Control and Prevention notes that risk factors for RA include genetics, but also factors such as smoking and obesity that can be managed by following a healthy lifestyle.
An early diagnosis of RA can allow for early treatment, which may help limit disease progression. Treatments for RA include medications to limit the immune response and inhibit inflammation. These treatments also help manage the complications of RA and can help improve quality of life. Talk with your rheumatologist to create a treatment plan that works best for you.
On myRAteam, the social network and online support group for those living with rheumatoid arthritis, members talk about a range of personal experiences and struggles. More than 148,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.
Have you encountered complications related to RA? How are you managing them? Share your experience in the comments below or by starting a discussion on myRAteam.