Rheumatoid Arthritis (RA) Complications

When you think of rheumatoid arthritis (RA), you might think of stiff, painful joints. But you may not know that complications can happen in other parts of your body.

The same process that hurts your joints can cause problems for your eyes, lungs, skin, heart, blood vessels, and other organs. And the medications you take for RA can have side effects.

You can manage the complications of rheumatoid arthritis. Just make sure to pay attention to problems early and get the right treatment.

Effects on the Skin

You might get lumps of tissue called rheumatoid nodules. They usually appear on your skin, especially on elbows, forearms, heels, or fingers. They can show up suddenly or grow slowly. The nodules may be a sign that your rheumatoid arthritis is getting worse. They can also form in places like your lungs and heart.

There’s also vasculitis, which is inflammation of the blood vessels. It makes spots on the skin that look like ulcers. When it affects larger arteries, it can lead to nerve damage, problems using your arms or legs, or damage to your internal organs.

Other types of skin problems related to RA may appear, so always let your doctor know about anything new that pops up or breaks out.

Eye Complications

Rheumatoid arthritis can affect your eyes in several ways. Inflammation of the episclera, a thin membrane that covers the white of your eye, is common. It’s usually mild, but your eye may be red and painful. Scleritis, an inflammation of the white of the eye, is more serious and can lead to vision loss.

RA also puts you at risk for Sjogren's syndrome. This happens when your immune system attacks the glands that make tears. It can make your eyes feel gritty and dry. It can also show up as dry skin, dry coughing, or vaginal dryness. You may need to use eye lubricants or take medications. Without treatment, eye dryness can cause infection and scarring of the conjunctiva, which is the membrane that covers the eye, and the cornea.

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Pain in the Neck

Rheumatoid arthritis is known to cause pain in the joints of the fingers and wrists. But it can also affect other parts of your body, like your neck. If your neck feels stiff and you have pain when you turn your head, it could be your RA.

Some simple exercises might help. Talk to your doctor about the best treatments to help ease your neck pain.

Heart and Blood Vessel Disease

Pericarditis, or inflammation of the membrane that surrounds your heart, usually develops during flares. Flares are times when your RA is worse.

If it happens a lot, pericarditis can make the membrane thicker and tighter. That can interfere with your heart's ability to work the way it should.

Rheumatoid nodules can also form on the heart and affect the way it works.

Inflammation of the heart muscle itself, called myocarditis, is a rare complication.

Rheumatoid arthritis can make you more likely to get cardiovascular disease. It also raises your risk of stroke. This is probably related to long-term inflammation.

Heart disease doesn't always have symptoms before a crisis. Your doctor can spot some problems during a checkup and may recommend lifestyle changes or medication.

Blood Disease

Rheumatoid arthritis or some of the medications that treat it can make it so you don’t have enough healthy red blood cells, which carry oxygen around your body. This is called anemia. Anemia symptoms include:

  • Fatigue
  • Rapid or uneven heartbeat
  • Shortness of breath
  • Dizziness
  • Headaches
  • Weakness
  • Leg cramps
  • Insomnia, or sleeplessness

Thrombocytosis is another complication from RA. This happens when inflammation leads to high levels of platelets in your blood. Platelets help your blood clot in order to stop bleeding, but too many can lead to conditions like stroke, a heart attack, or clots in your blood vessels.

Felty’s syndrome is an unusual complication with rheumatoid arthritis. This is when your spleen is enlarged and your white blood cell count is low. It can raise your risk of lymphoma, a cancer of the lymph glands.

Lung Problems

Rheumatoid arthritis can cause inflammation in your lungs, which can lead to pleuritis (pleurisy), a condition that makes breathing painful.

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Rheumatoid nodules can form in your lungs too. They’re usually harmless but can lead to problems such as a collapsed lung, coughing up blood, infection, or pleural effusion, which is fluid buildup between the lining of your lung and your chest cavity.

Interstitial lung diseases, which involve scarring of the lung tissue, and pulmonary hypertension, a type of high blood pressure that damages arteries in the lung and heart, can be complications of RA. Rarely, the drug methotrexate, which many people with RA take, can also cause lung problems. You might not notice any symptoms, so your doctor may want to do tests to watch for problems.

Osteoporosis

Osteoporosis makes your bones fragile and thin, so they’re more likely to break. People with RA are at higher risk of getting it. The disease may also cause bone loss, and so can some medications, like steroids. Also, if RA pain makes you less active, you might be more likely to get osteoporosis.

Symptoms of osteoporosis include back pain, stooped posture, a curved upper back, and fractures. You might also lose height.

Diabetes

Research shows that RA raises your risk for diabetes by about 50%. And diabetes raises your risk of arthritis, including RA and related issues, by about 20%.

Experts aren't exactly sure why these two diseases are linked. Several things may play a role:

  • RA and type 1 diabetes are both autoimmune diseases.
  • RA and diabetes both cause inflammation.
  • The stiffness and pain of RA can keep you from getting enough physical activity, a risk factor for type 2 diabetes.

Some medications that treat RA also affect your risk of diabetes. Steroids and statins can raise your blood sugar and make you more likely to get the disease. But other RA drugs may protect against it, including hydroxychloroquine, abatacept (Orencia), and a group of medicines called TNF inhibitors.

Infections

You may get more infections if you have rheumatoid arthritis. This could be from the condition itself or from the immune-suppressing medicine that treats it.

Emotional Effects

Living every day with the pain of a chronic condition can take a toll. One study shows that almost 11% of people with rheumatoid arthritis had symptoms of depression. The more severe the RA, the more depression the participants felt. Symptoms include:

  • Deep feelings of sadness, anxiety, emptiness, hopelessness, worthlessness, or guilt
  • Loss of interest in things you once enjoyed
  • Insomnia
  • Trouble concentrating or making decisions

If you have rheumatoid arthritis and feel anxious or depressed, discuss it with your doctor. There are many things they can offer that will help you feel better.

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Protect Yourself From RA Complications

You may not think to mention problems like depression, chest pain, or dry eyes to the doctor who treats your rheumatoid arthritis, but you should. All these problems can be related to the disease.

You might need different doctors and different treatments to control your RA and to take care of any new problems that come up. Always discuss new symptoms with your doctor.

WebMD Medical Reference Reviewed by David Zelman, MD on November 06, 2020

Sources

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