In the spring of 2006, Dora Burke finished her first triathlon with competitive results. When her ankle started hurting soon afterward, she chalked it up to the tough race. But in little over a month, this normally healthy, active mom in her 30s could barely move. Without warning, rheumatoid arthritis (RA) had rapidly and fiercely attacked nearly every joint in her body.
"The pain went from one body part, to four body parts," Burke says. "Then pretty immediately it went to the point where I couldn't lie down or walk or pick up my second child, who was 10 months old at the time. By the time I went to see the rheumatologist, I was completely disabled."
Although there have been cases of remission without rheumatoid arthritis treatment, these are not common. Most people with rheumatoid arthritis experience some progression of their disease during their lives.
But there are treatments that can help, and each person responds to the disease differently. What can you expect? That depends on many factors.
How advanced your rheumatoid arthritis is at the time you are diagnosed
Your age at the time you are diagnosed
How "active" your disease...
Burke approached the disease with courage and determination. And she remained admirably levelheaded about the risks of RA and its treatments.
Rheumatoid arthritis is a type of autoimmune disorder. With RA, the immune system attacks the body's own tissues, leading to chronic inflammation. An autoimmune disorder also leaves a person vulnerable to infections as well as a host of other medical conditions.
"My immune system is compromised at this point,” Burke tells WebMD. “I know now that I am at a heightened risk for a lot of things."
One disease that Burke is now at a higher risk for is lymphoma. That's a type of cancer that starts in the body's lymphatic system and interferes with the body's ability to make healthy blood cells. Several studies, including a 2008 review of the literature, have indicated that people with RA are two to three times more likely to develop lymphoma than people without RA.
RA and Lymphoma: Measuring the Risk
"The link between RA and lymphoma is very well known,” says John Sweetenham, MD. “However, lymphomas are relatively uncommon, so it's been difficult to figure out exactly how big the increased risk is." Sweetenham is director of clinical research for the Taussig Cancer Institute at the Cleveland Clinic in Ohio.
"The vast majority of people who have rheumatoid arthritis are never going to have this complication," says Sweetenham, who has treated patients with both conditions.
Some doctors, though, including Barton A. Kamen, MD, PhD, believe that severe RA may raise one's risk significantly more than the studies cited above say. Kamen is executive vice president and chief medical officer of the Leukemia & Lymphoma Society. He points out that around the time Burke was training for her 2006 triathlon, Swedish researchers announced that patients with the most severe disease activity from RA had a 70-fold increased risk for lymphoma compared with those with low severity. Having moderate-severity RA appeared to make a person about eight times more likely to develop lymphoma.
There is a very rare complication of RA called Felty's syndrome. It's defined by the presence of RA along with an enlarged spleen and an abnormally low white blood count. People with Felty's syndrome appear to be at an even higher risk of lymphoma.