Rheumatoid Arthritis (RA) Complications

The Effects of RA on the Joints, Organs, Skin, and More

In This Article

Rheumatoid arthritis (RA) is an autoimmune disease that causes systemic (all-over) inflammation. RA complications are known for affecting all parts of the body, not just the joints. The same inflammatory processes that cause joints to hurt and become damaged also cause problems to the eyes, lungs, skin, heart, blood vessels and more. RA also affects your emotional health. 

The good news is that you can manage RA complications. But it is important to pay attention to these problems early on and get appropriate treatments to manage complications before they become disabling and life-threatening. 

Bones and Joints

RA inflammation not only causes pain and stiffness, but it also causes long-term damage to your bones and joints.

Joint Damage

Ongoing RA inflammation can destroy the joint cartilage and bone around affected joints. Severe cartilage loss eventually leads to bones becoming deformed. Deformities make it hard to use an affected joint and may eventually lead to disability. RA joint damage is usually irreversible; the only way to fix damaged and deformed joints is with surgery.

Early and aggressive therapies in the form of biologic drugs can help to manage inflammation and pain and are disease-modifying, which means they can prevent damage and disability.

Prior to biologic drugs, people with RA often faced an inevitable future that included severe joint damage and disability. Biologic medicines contain compounds that copy antibodies produced by the body. 

The antibodies block out certain substances in the immune system that cause inflammation. This makes them different than older anti-inflammatory drugs previously used to manage RA, but unfortunately, better does not always mean safer.

Some of the more serious side effects of these medications include:

  • Susceptibility to serious infections
  • Low blood pressure
  • Anaphylaxis (life-threatening allergic reaction)
  • Increased risk for certain cancers
  • Serum sickness (a serious allergy)
  • Blood clots
  • Increased bleeding risk
  • Gastrointestinal problems
  • Anemia (too few red blood cells)

Despite some rare, serious side effects and safety concerns, biologics have improved quality of life for many people with RA. And while joint damage and deformities still occur in people in RA, instances are not as frequent or as severe as they were in the past, due to the ability of these drugs to slow down or stop joint damage altogether.

Osteoporosis

Osteoporosis is a disease that causes bone density loss, which makes fractures more likely. RA sufferers have an increased risk of osteoporosis. One 2012 study finds up to 23 percent of women with RA may develop osteoporosis. 

Reasons for the increased risk include:

  • Age: RA and osteoporosis are common in older people, especially post-menopausal women.
  • Smoking: People who smoke have an increased risk of developing both conditions.
  • Corticosteroid use: The use of corticosteroid drugs for treating RA increases osteoporosis risk.
  • The disease itself: RA has the potential to directly cause bone loss in joints affected by inflammation.

People with RA should talk to their doctors about the ways in which they can prevent bone loss. Your doctor might suggest calcium and vitamin D supplements, or even medications called bisphosphonates that slow down bone loss.

Organs

Most people know that RA affects joints and bones, but don’t realize RA also affects the organs, including the skin, eyes, and lungs. RA is a systemic disease, which means it affects the entire body. The effects on organs can be problematic if not properly managed.

Lungs 

Lung inflammation and inflammation of the pleura, the area around the lungs, affects up to 80 percent of people with RA, according to the Arthritis Foundation. Neither condition causes symptoms, although some people may feel short of breath.

If you experience shortness of breath or difficulty with breathing, talk to your doctor about medications to help reduce lung inflammation.

Heart

Research reported in the journal Rheumatology: Current Research in 2013, shows that people with RA are 50 percent more likely to die from a cardiovascular problem, two to three times more likely to have a heart attack, and nearly twice as likely to have a stroke.

Congestive heart failure is another complication of RA. It is not necessarily a direct complication, but it is common in people who have dealt with heart inflammation for many years.

Many people with RA develop pericarditis (inflammation of the pericardium) at the onset of their RA. The pericardium is the double-walled sac containing the heart and the roots of major blood vessels. Some people may even experience chest pain that is not heart-related.

Any and all chest pain should be reported to your doctor, regardless of the nature and location of the pain.

Eyes

The most common eye-related symptom of RA is dryness, and dry eyes are susceptible to infections. Untreated, severe dry eyes can cause damage to the cornea, the clear, dome surface of the eye that maintains your focus.

Dry eyes are sometimes a symptom of Sjogren’s syndrome, an autoimmune disorder often associated with RA. You should report eye pain, vision and other eye problems to your doctor who can adjust your treatments to better manage inflammation. You should also consult an ophthalmologist for evaluation to avoid vision-threatening complications.

Skin Problems

Numerous skin problems are associated with RA and the severity of these depends on how severe RA disease activity is. Further, medications that treat RA may also affect your skin.

Rheumatoid nodules (tissue lumps caused by localized swelling and inflammation) and vasculitis are common skin issues associated with advanced RA. Vasculitis affects the blood vessels that supply blood to the fingers and toes causing them to be red and sore at the tips of fingers and toes. It also causes pitting (shallow or deep holes) in the nails.

Blood Diseases

Several blood disorders are associated with RA including anemia, thrombocytosis, and Felty’s syndrome.

  • Anemia is a condition of reduced red blood cells. It may cause fatigue, rapid heartbeat, shortness of breath, dizziness, leg cramps, and sleep problems.
  • Thrombocytosis happens when ongoing inflammation eventually leads to high levels of blood platelets. You need platelets to help the blood to clot and stop bleeding, but too much can result in strokes, heart attacks or blood clots in blood vessels.
  • Felty’s syndrome is a rare and unusual complication of RA. It causes the spleen to become enlarged and white blood counts to be low.  It may also increase the risk of cancer of the lymph glands, called lymphoma.

Emotional Health

Being diagnosed with a life-long condition and managing daily pain and fatigue can trigger depressed feelings and anxiety. Some of this is normal and is exacerbated by a variety of factors, including how active your disease is.

Research shows up to 42 percent of people with RA experience depression, which in the long-term can also affect physical health. Additionally, research has shown that depression and suicidal ideation in people with RA increases with “pain, hardships, treatment denial, and prognosis.” All these factors combined reduce the overall quality of life.  

It is common for people with RA to have intermittent episodes of depression related to their symptoms getting worse and high levels of pain. But if symptoms of anger, sadness, and anxiety are long-lasting and affect daily life, talk to your doctor about what you can do to manage these. Treating depression and anxiety is important to living a full and happy life despite RA.

If you are experiencing suicidal thoughts, reach out to someone you trust. Don’t let fear or embarrassment keep you from getting the help you need and deserve.

If you are thinking about committing suicide call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the National Hopeline Network at 1-800-SUICIDE (1-800-784-2433).

Both are crisis hotlines that offer 24-hour suicide support. Calls are free and confidential.

Additional Complications

Additional complications of RA include voice box inflammation, mouth problems, ligament and tendon damage and susceptibility to infection.

Voice Box

RA can affect the cricoarytenoid joint (the voice box) located in your larynx. Inflammation can lead to hoarseness, which is also a symptom in people with Sjogren’s syndrome. 

Mouth Problems

RA inflammation also causes dry mouth and irritation and infection of gums. Dry mouth increases the risk of dental problems, including tooth decay and loss.

A dry mouth can also cause yeast infections of the mouth. These infections cause the tongue to become white, while dryness can make it tender, red and cracked. If you experience mouth dryness or a sore tongue, call your doctor.

Ligament and Tendon Damage

In addition to joint damage, RA inflammation impacts connective soft tissues, including ligaments and tendons. Tenosynovitis is quite common in people with RA, but interestingly, most people don’t experience tendon pain until the damage is done. 

Tenosynovitis most often affects hands and fingers, but any area of connective tissue supporting a joint can be affected, including the elbows and shoulders. 

Nerve Damage

Neck pain and balance problems in people with RA are a possible sign of nerve damage. RA can also affect the top of the spinal cord, called the cervical spine. The deterioration of the joints in your neck can lead to irritation and put pressure on the nerves of the spine.

Signs of nerve damage include:

  • Neck pain
  • Balance and coordination problems, including with walking
  • Numbness in the hands and feet
  • Weakness the extremities
  • Loss of fine motor skills

RA can also affect the peripheral nerves outside the brain and spinal cord. The disease may compress on the median nerve, which runs from the forearm to the wrist and into the hand. Median nerve problems may eventually cause carpal tunnel syndrome, a condition that causes pain, numbness or weakness in the hands and wrist, and may eventually lead to loss of hand function.

Infection

People with RA are more susceptible to infections. This is related to both the disease and also the immune-suppressing medications used to treat it. 

You can cut your infection risk by:

  • Eating a balanced diet
  • Washing hands often
  • Not smoking
  • Getting plenty of sleep
  • Getting flu and pneumococcal vaccinations
  • Avoiding sick people

You may also wish to talk to your doctor about supplements that may improve immune system function, such turmeric

If you are using a biologic drug and develop a fever or signs of infection, call your doctor.

A Word From Verywell

It is important to get the right treatment for RA as early as possible. Treatment can increase the likelihood of remission and reduce the risk of joint damage and other potential RA complications. There are many treatments available and you and your doctor can work together to find a treatment plan that fits your unique situation.

You may not think you need to tell your doctor about all your symptoms, such as depressed mood, dry eyes, or chest pain, but you should. These things might be related to RA, or not, but in the long-term, they could seriously affect your overall health and outlook.

You may need different doctors and different treatments to take care of new problems that come up, but that should not deter you from speaking up. Always be sure to discuss any new, worsening or concerning symptoms with your doctor.

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