Even though rheumatoid arthritis (RA) is primarily a disease of the joints, it can have effects throughout the body. Inflammation from the condition, the medications used to treat it, and related autoimmune disorders can all cause complications and comorbidities — co-occurring conditions — in people with rheumatoid arthritis.

RA is a chronic condition that gets worse over time. 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 healthcare team if you experience any new or unusual symptoms.

Other Conditions of the Bones and Joints

Symptoms of rheumatoid arthritis are caused by inflammation that leads to joint swelling, stiffness, pain, and damage. However, RA can also affect the bones, tendons, ligaments, and other organs, leading to conditions that extend beyond the joints.

Osteoporosis

RA is associated with an increased risk of developing osteoporosis. Osteoporosis (and the milder osteopenia) occurs when new bone isn’t being created as fast as older bone is being destroyed, which leads to an increased risk of fractures. Inflammation, bed rest (due to joint pain), and long-term treatment with corticosteroids can all increase osteoporosis risk in RA.

Carpal Tunnel Syndrome

RA can lead to carpal tunnel syndrome in about 30 percent of people. Inflammation from RA and joint deformities (due to long-term joint impairment or poorly treated disease) can cause compression of the median nerve in the wrist, leading to pain, numbness, and weakness in the hands.

Autoimmune Diseases

People with RA are at an increased risk of having other autoimmune diseases or rheumatic diseases. Autoimmune diseases occur when the immune system attacks itself. 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. The following are the most common.

Lupus

According to one study, 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.

Psoriatic Arthritis

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 sometimes occur outside of a psoriasis diagnosis.

Sjögren’s Disease

Sjögren’s disease is the third-most common autoimmune condition seen with RA. Sjögren’s usually causes dryness in the eyes and mouth but can also affect other areas. This dryness is due to decreased production of tears and saliva, as well as other symptoms affecting other parts of the body.

Heart Diseases

Rheumatoid arthritis increases a person’s risk of developing several cardiovascular diseases (diseases affecting the heart and blood vessels). Widespread inflammation from RA can impact the heart muscle. It can also affect the sac surrounding the heart.

Rheumatoid arthritis puts a person at a higher risk for serious heart complications, including:

• Heart attack
• Heart failure
• Stroke

In fact, heart attacks and strokes are among the most common complications rheumatologists see with RA. People with the condition may have twice the risk of experiencing a heart attack compared to the general population.

Atherosclerosis

Some of this risk may be due to the fact that RA is associated with an increased risk of developing atherosclerosis, the formation of fatty plaques inside arteries. Atherosclerosis can contribute to coronary artery disease, a blockage of the blood vessels that carry oxygen to the heart muscle, which can lead to a heart attack. The increased risk is linked to the ongoing inflammation in people with RA, which over time can damage blood vessels and lead to early atherosclerosis.

Rheumatoid Vasculitis

Rheumatoid vasculitis is a rarer 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. It’s directly tied to an increased risk of experiencing a stroke.

Lung Conditions

RA can be associated with several lung diseases, including interstitial lung disease, which causes scarring of the lungs. Severe pulmonary fibrosis is a life-threatening condition that can require a lung transplant. RA has also been associated with pleural effusion, a buildup of fluid in the space around the lungs.

Chronic Obstructive Pulmonary Disease

Rheumatoid arthritis is also connected to chronic obstructive pulmonary disease (COPD). This condition reduces the amount of air that you can breathe into and out of your lungs. People with COPD may feel chest pain or pressure or as though they can’t breathe. This can cause anxiety, which may make some other symptoms of RA worse. Some medications used to treat RA may make this worse, so it’s important to see a doctor if you think you’re experiencing any breathing or chest symptoms.

Infections

People with RA are also more likely to develop infections than people without the condition. In fact, they’re about twice as likely to have an infection severe enough to require hospitalization. This means that people with RA need to be especially careful after they have surgery, because they may be more likely than others to end up with an infection. This increased risk is also due to the immunosuppressant medications used to treat RA. These medications hold back the immune system to lower the inflammation in the body, but this can also reduce your body’s ability to fight an infection.

Gastrointestinal Problems

Gastrointestinal problems are also about 70 percent more common in people diagnosed with rheumatoid arthritis than in people without RA. Medications, inflammation, and infections are all common causes of these issues. However, other medical conditions can also cause these sorts of problems. One of the most common causes of gastrointestinal problems is the frequent use of NSAIDs for joint pain. The use of gastroprotective medications can reduce this side effect. Corticosteroids (steroids) can also cause stomach pain, so it is important not to mix corticosteroids and NSAIDs.

Sleep Disorders

Rheumatoid arthritis can affect the way you sleep.

Insomnia

In one study, 63 percent of people diagnosed with RA struggled with insomnia (difficulty falling or remaining asleep). Additionally, 20 percent struggled with disturbed sleep. This means that they might be able to fall asleep, but they don’t sleep well and may struggle to stay asleep all night.

Obstructive Sleep Apnea

Rheumatoid arthritis is also associated with obstructive sleep apnea (OSA), which causes affected individuals’ airways (the path air travels to and from your lungs) to become blocked at night. People stop breathing, then suddenly start again. This can happen anywhere from a few times to hundreds of times each night. The higher risk for this may be connected to structural changes in the body, obesity, or inflammation.

Restless Legs Syndrome

RA is also connected to restless legs syndrome (RLS). In one study, 63 percent of people living with RA also lived with RLS. If you have this condition, your legs might start to feel uncomfortable in the evening as you’re trying to sleep, and it feels like the only way to alleviate that discomfort is to move your legs. This makes it difficult to fall asleep and stay asleep.

Cancer, Anemia, and More

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 lymphoma, other cancers, and rheumatoid nodules.

Anemia — low levels of red blood cells — can be associated with RA and manifest with symptoms such as fatigue.

In addition, RA can cause inflammation of the eyes, including vasculitis and scleritis.

Researchers have also found that individuals with RA face a higher risk of depression and dementia.

Effect of Complications and Comorbidities

RA complications and comorbidities contribute to an overall decreased life expectancy. Although many factors affecting the development of RA-related conditions cannot be controlled, there are certain things that you can do to help improve long-term outcomes.

If you smoke, 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.

It is important to understand that good management of the disease can prevent complications and comorbidities, in addition to lowering the risk to other organs.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, 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.