What Comorbidities Exist in Rheumatoid Arthritis?

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Living with rheumatoid arthritis (RA) can be a struggle. It is a chronic autoimmune inflammatory disease that can be managed but gets worse over time. Adding to the challenges, RA isn’t a lone condition. It puts you at risk for a host of comorbid diseases.

Comorbid conditions associated with RA include cardiovascular diseases, gastrointestinal, renal, and pulmonary diseases, infections, osteoporosis, cancer, and mood disorders. Here is what you need to know about comorbidities in people with RA, their effect, and how to reduce your risk.

Comorbidity Defined

The term comorbidity is used to define the presence of one or more diseases in a person in addition to a primary condition. Conditions considered comorbidities are usually chronic diseases.

Other terms used to describe comorbid conditions are coexisting or co-occurring conditions. The term multimorbidity is used to describe multiple diseases in the same person.

Up to 67.1% of people with RA have one or more comorbid conditions. Comorbidities of RA can make RA more fatal. Research shows people with RA are twice as likely to die from comorbid conditions like heart and respiratory problems before age 70, according to a study published in 2018 in the journal Arthritis Care and Research.

There are two categories of comorbidities that affect people living with RA—those that are a direct result of the disease (inflammatory process, physical effects of the condition, and mental health issues related to coping) and those resulting from the treatments caused by the disease.

While the medications you take for rheumatoid arthritis can ease pain and inflammation, and even slow down or stop the disease, they don’t always work for everyone, leading to severe complications, including disability and organ disease.

If not managed effectively, comorbidities may increase the risk of disability and life-threatening complications.

Comorbidities Affecting People With RA

According to a study reported in 2018 reported in the journal Reumatologia, the most common comorbidities associated with RA are cardiovascular diseases, gastrointestinal, renal, and pulmonary diseases, infections, osteoporosis, cancer, and depression.

Cardiovascular Disease

According to the Arthritis Foundation, people with RA are twice as likely to develop heart disease in comparison to those without the condition. This can have serious consequences. RA-related heart disease accounts for one-third to one-half of RA-related deaths.

Cardiovascular diseases connected to RA include ischemic heart disease, congestive heart failure, heart attack, high blood pressure, peripheral vascular disease, atherosclerosis, acute coronary syndrome, and atrial fibrillation.

A 2015 report in the journal Nature finds people with RA are more likely to develop atherosclerosis—a chronic, progressive condition that causes a buildup of fats, cholesterol, and plaque in the blood vessels of the arteries of the heart. People with RA can develop atherosclerosis at a faster rate than people without RA.

People with RA experience more severe acute coronary syndrome (ACS), conditions that cause sudden, reduced blood flow to the heart. ACS conditions include heart attack and unstable angina.

In a study reported in 2018 in the Journal of the Heart Association, researchers found RA was associated with increased incidences of hospitalization for heart failure and RA was a significant risk factor for ACS. The risk in people with RA was 1.3 times higher than for others in the general population.

Acute coronary syndrome in people with rheumatoid arthritis is associated with a 30% risk for early death.

One of the best ways to protect your heart is by taking all the medications your doctor has prescribed for you—whether it is methotrexate, a biologic drug, or other treatment. There are also lifestyle interventions that can help, including staying active, eating right, managing stress, and not smoking.

You should also watch your blood pressure and cholesterol numbers. If they are high, talk to your doctor about what you can do to lower them. Your doctor will likely suggest things like exercise, diet, and medication.

You should also ask about alternate pain treatments, as nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can increase the risk of heart problems.

Gastrointestinal Disease

Studies show people with RA are more likely to have gastrointestinal (GI) troubles compared to others without the condition. A study reported in 2012 in the Journal of Rheumatology finds people with RA have an increased risk for upper and lower GI events compared to people without the condition.

Upper GI events include peptic ulcers, stomach bleeds, obstructions, and esophagitis. Lower GI events include diverticulitis and ischemic colitis.

Researchers believe RA affects the GI tract because of the medications used to treat it, increased risk for infection, and unchecked inflammation. Work with your doctor to keep your RA under control and report any signs of GI problems right away.

Signs of a GI problem may include bloating, gas, frequent constipation or diarrhea, blood in stools, ongoing heartburn, nausea and vomiting, belly pain, swallowing problems, and unexplained weight loss or gain.

Renal Disease

RA inflammation is believed to affect kidney function and can lead to renal disease—a condition where the kidneys stop working and become unable to remove waste and excess fluid from the blood.

A study reported in 2015 by the journal PLoS One finds people with RA have a higher risk for kidney disease because of inflammation, other comorbidities like high blood pressure, and renal toxicity from medications used to treat RA.

One of the best ways to reduce the risk of kidney problems with RA is to control inflammation. You will also need to work towards reducing your risk for kidney disease, which includes reducing pain medication use, losing or maintaining weight, adopting a low-sodium diet, being active, and keeping blood pressure and cholesterol managed.

And because you are taking medications that increase your risk for kidney problems, your doctor will want to monitor your kidney function to make sure your kidneys are working properly.

Pulmonary Disease

RA can cause pulmonary (lung) conditions that block airflow and make it harder to breathe. According to the Arthritis Foundation, 10% of people with RA will develop some type of rheumatoid lung disease.

Lung problems associated with RA include:

  • Interstitial lung disease (ILD): Scarring related to chronic lung inflammation causes shortness of breath, a chronic dry cough, and fatigue. The scarring buildup can make it harder for oxygen to enter the bloodstream. Untreated, ILD can become severe and cause life-threatening complications, like respiratory failure.
  • Rheumatoid nodules: Small lumps may appear on the lungs following years of chronic inflammation. While lung nodules do not increase the risk for lung cancer, a nodule can rupture and cause a collapsed lung.
  • Pleural disease: The pleura­—the tissue surrounding the lungs—can become inflamed. There may be fluid buildup in the two layers of the pleura. If the fluid doesn’t clear up and gets worse, you may experience shortness of breath, fever, and pain with breathing.
  • Small airway obstruction: Sometimes the walls of the lungs can become thickened from chronic inflammation, injury, or infection. This can cause mucus buildup in the lungs, shortness of breath, and a chronic dry cough. 

Treatment for RA lung issues is aimed at reducing inflammation, suppressing the immune system, and removing fluid from the lungs.

You can protect your lungs by not smoking, getting your flu and pneumonia vaccines, getting regular check-ups, and contacting your doctor right away if you experience shortness of breath or dry cough.

Infections

People with RA have an increased for infections related to their malfunctioning immune systems and the medications used to treat RA. A study reported in 2019 by the journal RMD Open finds people with RA have a high risk for serious infections compared to people with non-inflammatory rheumatic and musculoskeletal diseases.

Serious infections associated with RA include bacterial, respiratory, bloodstream, sepsis, skin, bone, and joint infections. The highest risk for serious infections is in people who have high RA disease activity. The Johns Hopkins Arthritis Center reports that RA-related infections account for one-quarter of deaths in people with RA. 

You can reduce risk of serious infections by getting your flu and pneumonia vaccinations. You should also avoid sick people, and if you have to be around someone who is sick, wear a surgical mask. Consider taking supplements containing turmeric, garlic, cinnamon, or zinc to give your immune system a boost.

Work with your doctor to make sure you are getting the safest medications and lowest doses to treat RA and to keep your infection risk down. And if you develop symptoms of an infection—fever, chills, a sore throat, cough—call your doctor right away.

Osteoporosis

Studies have shown that there is an increased risk of bone loss and fractures in people who have RA. People with RA also have an increased risk for osteoporosis, a condition where bones become weak and brittle and are more likely to fracture.

This increased risk is linked to the medications used to treat RA, including glucocorticoids, which are known for triggering bone loss. Pain and loss of joint function related to inactivity can also increase osteoporosis risk. Additionally, bone loss in people with RA might a consequence of the disease itself.

If you have RA, you should talk to your doctor about the ways in which you can decrease your risk for bone loss, fracture, and osteoporosis.

This may include things like:

  • Getting inflammation under control
  • Practicing low impact exercise to help you stay fit and improve your balance
  • Maintaining a healthy diet high in calcium and vitamin D
  • Not smoking or drinking alcohol in excess as both contribute to bone loss.
  • Seeing your doctor regularly to check for signs of osteoporosis
  • Taking extra care to avoid slipping or falling
  • Working with a physical or occupational therapist to find safer ways to exercise and perform daily tasks
  • Taking bone-preserving medications to stop bones from breaking down

Cancer

When compared to people without RA, people with RA are at a greater risk for various cancers, including lymphoma, lung cancer, and skin cancer.

A 2015 meta-analysis reported in the journal Arthritis Research and Therapy shows the incidence of cancer might be the highest in the first several years after an RA diagnosis. Researchers speculate this heightened susceptibility is related to a variety of factors, including genetics, lifestyle, the disease itself, and medications used to treat RA.

While some cancer risk factors might be out of your control, it is still a good idea to be mindful of the things you can control. For example, you shouldn’t smoke as smoking increases the risk for many types of cancers, including lung cancer.

And because some researchers think chronic inflammation plays a role in the increased risk for cancer, it might be helpful to keep inflammation levels down. You should let your doctor know if your current plan isn’t helping or if you are still experiencing high levels of pain, fatigue, and other RA symptoms. 

Mood Disorders

Mood disorders like depression and anxiety are common in people with RA. In fact, research shows having an autoimmune disease like RA increases the risk of depression, anxiety, and bipolar disorder.

Reasons for the connection between RA and several mood disorders are often related to the disease itself and external factors of the disease. For example, there is evidence showing that high levels of inflammation contribute to the development of depression in people with RA. 

Additionally, living a chronic condition like RA causes chronic stress, which can eventually lead to depression and anxiety. And depression and pain tend to feed off each other—that is, RA pain leads to depression, and depression worsens the way pain is perceived.

Taking steps to live healthier can reduce your risk for a mood disorder with RA. This includes things like eating healthy, keeping active, getting enough sleep, and finding ways to manage stress.

Talk to your doctor if you think you may be experiencing signs of a mood disorder. Symptoms may include feeling down or angry all the time, sleep problems, reduced appetite, problems with concentration, excessive worrying, racing thoughts, and behaviors that seem out of the norm for you.

A Word From Verywell

It is important to be aware of the conditions associated with RA so you can identify new or worsening symptoms. You may not think you need to mention problems like chest pain, gastrointestinal troubles, or depressed mood to the doctor treating your rheumatoid arthritis, but you should.

All these things are related to RA and can make your disease worse or cause life-threatening complications. Even if you are not sure if these symptoms are RA-related, your doctor is in the best position to identify your risk factors, request screenings, and refer you to other specialists and providers. But that starts with you speaking up and sharing concerns and worries with your healthcare provider.

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