Although rheumatoid arthritis (RA) is primarily a disease of the joints, it can have effects throughout the body. Inflammation from the condition, medications used to treat it, and related autoimmune disorders can all cause complications and comorbidities — co-occurring conditions — in people with rheumatoid arthritis.
Members of myRAteam often talk about the conditions they have in addition to rheumatoid arthritis. “I have lupus, RA, osteoarthritis, and fibromyalgia,” one member wrote. Another said, “I have had RA and psoriatic arthritis since age 15 — now I am 50. It does not get easier, that's for sure.”
It’s important to understand the range of other conditions that might affect people living with RA. That way, you’ll know what to look for and will be prepared to talk with your health care team if you experience any new or unusual symptoms.
Symptoms of rheumatoid arthritis are caused by inflammation that leads to joint stiffness, joint pain, and joint damage. However, RA can also affect bones, tendons, and ligaments, leading to conditions that extend beyond joint issues.
RA is associated with a twofold increased risk of developing osteoporosis. Osteoporosis (and the milder osteopenia) occur due to a loss of bone density, which leads to an increased risk of fractures. Inflammation, decreased physical activity, and long-term treatment with corticosteroids can all increase osteoporosis risk in RA.
RA can sometimes lead to carpal tunnel syndrome. Inflammation from RA can cause compression of the median nerve in the wrist, leading to pain, numbness, and weakness of the hands.
People with RA are at an increased risk of having other autoimmune diseases or rheumatic diseases. Autoimmune diseases occur when the body produces autoantibodies — such as rheumatoid factor and anti-cyclic citrullinated peptide antibodies — that attack healthy tissue and cause chronic inflammation. About 25 percent of people with RA have one or more additional autoimmune diseases.
There are dozens of autoimmune disorders that can occur alongside RA. Following are the most common.
The most common comorbid autoimmune disease seen with RA is systemic lupus erythematosus (SLE). SLE can affect all parts of the body, causing pain, inflammation, and a host of other symptoms.
The second most common autoimmune disease seen in people with RA is psoriatic arthritis (PsA). Psoriatic arthritis, as the name implies, is usually associated with psoriasis of the skin, an autoimmune disease that causes scaly patches of skin to build up. However, PsA can occur outside of a psoriasis diagnosis.
Sjögren’s syndrome is the third most common autoimmune comorbidity seen with RA. Sjögren’s causes dry eyes and mouth due to decreased production of tears and saliva, as well as other symptoms affecting other parts of the body.
Some people with RA have multiple conditions at the same time. “I went to my doctor last week and she said on top of my RA, osteoporosis, and lupus, I now have Sjögren’s syndrome,” one myRAteam member wrote. “Guess I’m being tested somehow.”
Watch rheumatologist Dr. Iris Navarro-Millán talk about the connection between RA and cardiovascular disease.
Rheumatoid arthritis increases a person’s risk of developing several diseases affecting the heart and blood vessels. Widespread inflammation from RA can impact the heart muscle, causing myocarditis. It can also affect the sac surrounding the heart, causing pericarditis, which can lead to chest pain and other heart symptoms.
RA is associated with an increased risk of developing atherosclerosis, the formation of fatty plaques inside arteries. Atherosclerosis can contribute to coronary artery disease — blockage of the blood vessels that carry oxygen to the heart muscle — which can lead to a heart attack.
Rheumatoid vasculitis is another complication of RA. This can cause ischemia — lack of blood flow — to various organs including the skin, nerves, and eyes. Rheumatoid vasculitis can lead to serious complications and permanent loss of function.
RA can be associated with several lung diseases, including interstitial lung disease that causes pulmonary fibrosis, or scarring of the lungs. Severe pulmonary fibrosis is a life-threatening condition that can require a lung transplant to treat. RA has also been associated with pleural effusion, a buildup of fluid in the space around the lungs.
RA has been linked to a variety of conditions that can affect the entire body. People with RA are at a higher risk of developing high blood pressure (chronic hypertension), high cholesterol (hypercholesterolemia), type 2 diabetes, and obesity, all of which are risk factors for cardiovascular disease.
Anemia — low levels of red blood cells — can be associated with RA and manifest as symptoms including fatigue. In addition, RA can cause inflammation of the eyes, including uveitis and scleritis. People with RA are also at higher risk of developing non-Hodgkin lymphoma, a blood cancer that typically affects the lymph nodes. Researchers have also found that individuals with RA face a higher risk of having depression and dementia.
Medications used to treat RA include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs), such as methotrexate.
Long-term use of corticosteroids, like prednisone, can lead to several complications. Corticosteroids help suppress the immune system, which is important for treating RA, but can also lead to an increased risk of infections. Chronic corticosteroid use also can contribute to osteoporosis.
Long-term use of NSAIDs and methotrexate can lead to kidney disease. Long-term use of acetaminophen (Tylenol) can be associated with liver disease, though regular lab monitoring can minimize these risks.
RA complications and comorbidities contribute to an overall decreased life expectancy. Many factors affecting the development of RA-related conditions cannot be controlled. However, there are certain things that you can do to help improve long-term outcomes.
If you smoke, then quitting smoking can help decrease the risk of heart and lung conditions. Weight loss, healthy eating habits, and physical activity can also help prevent or minimize cardiovascular and pulmonary complications of RA — and improve your overall health.
On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 191,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.
Are you living with other conditions in addition to RA? Share your experience in the comments below, or start a conversation by posting on your Activities page.