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Unless you know someone with rheumatoid arthritis (RA), you may not realize it affects more than joints. That’s because it’s more than just a joint disease.

RA is an autoimmune disease. It happens when your immune system, which is supposed to keep you healthy, starts attacking your body’s joints and other tissues.

RA causes joint pain and stiffness -- as does osteoarthritis (OA), the most common form of arthritis. But unlike OA, RA can cause extreme fatigue, fevers, and other, potentially serious health problems throughout your body.

Treatment with one or more types of disease-modifying antirheumatic drugs (DMARDs) is crucial. These medications suppress your immune system in ways that slow down the disease. Other medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), help address symptoms.

RA often attacks the small joints: those in your wrists, hands, and feet. It also tends to strike symmetrically (both sides of the body). So, if you have RA in your left foot, there’s a good chance you’ll have it in your right one.

Don’t dismiss pain or other symptoms in other parts of your body, though. RA can affect any joint. It can also affect your heart, lungs, eyes, and other organs.

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Joints

When your immune system mounts an attack on your joints, it creates inflammation. Your joints may feel tender, warm and swollen. They might be especially stiff first thing in the morning. You might feel tired all the time. Inflammation targets the lining of the joint, known as the synovial membrane. But RA inflammation can damage much more, including:

  • Bone
  • Cartilage (tissue that covers the surface of joints)
  • Nearby tendons

Over time, RA can deform your joints and make them work less well. Disease-modifying medication reduces the risk of joint damage. In some cases, surgery can help restore lost function.

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Bones

Your bones could become thinner and weaker due to chronic inflammation or certain RA medications, such as corticosteroids. When bones lose strength, they’re more likely to break. This usually happens without symptoms. A fracture may be your first clue that something is wrong.

The good news is that bones constantly rebuild themselves. To help strengthen them even more, your doctor may suggest:

  • High-calcium foods
  • Vitamin D supplements
  • Strength training
  • Balance exercises
  • Weight-bearing exercises that produce impact, such as walking
  • Medications, including bone-building drugs

Heart & Blood Vessels

The same inflammatory substances that attack your joints in RA can also wreak havoc on your heart and blood vessels, also known as your cardiovascular system. This can lead to:

  • Atherosclerosis (plaque buildup in arteries), the main cause of heart attack and stroke. When you have RA, you often have no symptoms before a major event.
  • Pericarditis, or inflammation of tissue around the heart, which can lead to chest pain
  • Vasculitis, or inflammation of blood vessels that can reduce blood flow, which can lead to eye irritation, and sores

Some drugs for RA also play roles in your cardiovascular health, for better and for worse. Disease-modifying medications for RA can reduce your risk of cardiovascular problems. NSAIDs can increase the risk of heart attack and stroke.

Your doctor should pay special attention to your cardiovascular health if you have RA. Expect regular tests of your blood pressure, blood sugar, and cholesterol. You may also need to limit your use of NSAIDs.

Lungs

RA inflammation can affect the lungs, but this often doesn’t cause symptoms. When lung issues come up in RA, they could be one of several conditions, such as:

  • Pleurisy. Inflammation of the lining of the lungs that causes sharp chest pain when you breathe
  • Interstitial lung disease (ILD). Inflammation and scarring of lung tissue
  • Methotrexate lung. Pneumonia-like symptoms caused by this common DMARD
  • Tuberculosis (TB). This potentially serious bacterial infection is a complication of DMARDs. Your doctor will check you for TB before starting you on biologics.

If you have any symptoms of possible lung problems, like shortness of breath or chest pain, let your doctor know right away. You’ll need an accurate diagnosis to begin the right treatment.

Eyes

Glaucoma raises pressure inside your eye

RA-related eye problems are common. Some are just uncomfortable; others put your vision at risk. They could include:

Extreme dryness. Dry eye syndrome (keratitis sicca) occurs when your eyes can’t maintain a normal surface layer of tears. It may be related to RA itself or the medications you take for it. Treatments include trying a new RA med or a lower dose of your current one, artificial tears, and prescription eyedrops such as cyclosporine (Restasis).

Inflammation. When it affects the white part of your eye, called the sclera, it’s called scleritis. It can be painful and make your eye swollen, red, or tender. If you have these symptoms, call your doctor as soon as possible to help prevent vision loss. You’ll likely need prescription medications and eyedrops. In severe cases, you may need eye surgery to limit vision loss.

Glaucoma. Corticosteroids increase the risk of glaucoma, a buildup of fluid inside your eye. As the pressure in your eyeball increases, it can damage the optic nerve and cause vision loss. Glaucoma often has no symptoms at first, which is why you need to get regular eye exams. After you’ve had it a while, you might see halos or notice blind spots in your vision. Eyedrops, oral medication (pills), and laser treatments can help reduce the pressure and slow vision loss.

Cataracts. Inflammation can cause the lens inside your eyeball to become cloudy. The result is hazy or blurry vision. Eventually, you may need surgery to remove the cloudy lens and replace it with a new, clear one.

Glaucoma raises pressure inside your eye

Kidneys

Kidney disease is more common in people who have RA than in people who don’t have it. Both inflammation and medication contribute, which can complicate treatment.

Symptoms can be hard to spot early in the disease, so talk to your doctor about your risk for kidney damage and ways to recognize a problem. To help protect your kidneys, you may need to:

  • Take a lower dose of your medication(s)
  • Get regular blood and urine tests to measure kidney function
  • Lower your blood pressure and cholesterol
  • Drink more water and limit how much sodium you use

Medications are crucial to controlling RA-related damage, including kidney disease. RA drugs are generally safe for people with healthy kidneys. But if you already have kidney problems, you may need to avoid certain drugs such as NSAIDs, corticosteroids, methotrexate, and cyclosporine.

Liver

RA causes body-wide inflammation, but it doesn’t appear to target your liver. Some drugs you take for RA could be a problem for this organ, though. These include the pain reliever acetaminophen and the DMARD methotrexate.

Chances are your doctor already monitors your liver via regular blood tests, but it’s always smart to advocate for your own health. You may not notice any symptoms. Ask about potential risks to your liver based on the medications and dosages you take and ask if you should consider alternatives that may have fewer potential side effects.

Alternative Treatments for RA

Stomach

When you’re in pain, prescription RA drugs can make a big difference. The catch is that they can also cause side effects, including stomach problems. DMARDs, NSAIDs, and corticosteroids can all make your belly ache.

Sometimes you just have mild pain, bloating, constipation, or diarrhea. Less often, your RA drug can cause severe irritation, or even ulcers and bleeding, in your digestive tract.

If you have stomach problems, tell your doctor right away. You may need a medication adjustment. Or the doctor may find out that something else, such as another condition, is at the root of your tummy trouble.

Emotions

RA can be a major source of stress. It can tax you physically and financially, and it can damage your self-esteem and relationships. For many people, the pain and limitations of RA become a source of chronic anxiety or depression.

It’s important to bring up these feelings with your rheumatologist. Emotional distress can make your physical symptoms feel worse. Conversely, worse physical symptoms can truly test your emotions.

The first step to improving your emotional state may well be better management of your RA. Other ways to feel emotionally better include:

  • Self-care strategies (exercise, meditation, and creative outlets)
  • Social activities
  • Professional counseling

Ears

For such a small part of your body, your ears have a lot going on inside. RA and its treatments can affect the interior structures -- including joints, nerves, and hair cells -- and result in hearing loss. Rheumatoid nodules, or small lumps of tissue under the skin, can also form in the ears and affect hearing.

Smoking is also a risk factor for hearing loss, since it contributes to the development of rheumatoid nodules.

Mouth

Everyone gets a dry mouth sometimes. When you have RA, it could be a chronic problem. RA inflammation can damage moisture-producing glands in your mouth. To keep your mouth moist, drink water, try over-the-counter saliva products, and/or talk to your doctor to see if you need medications to increase the amount of saliva your mouth makes.

If you take methotrexate, chronic dry mouth and painful mouth ulcers are common side effects. The doctor may give you folic acid supplements to prevent the sores. A topical pain reliever can help, but you may need to try a new medication if the ulcers become too bothersome.

Nerves

RA can affect your nerves in two main ways: by compressing them or damaging them.

Carpal tunnel syndrome. You may think of carpal tunnel syndrome as a problem for people who type a lot. RA can also contribute to this common condition, which causes hand pain, numbness, and tingling. Carpal tunnel syndrome happens when the nerve that controls sensation and movement in the hands is compressed. Splints and steroids can provide some relief, but you may need surgery.

Peripheral neuropathy. RA inflammation can damage the nerves in your hands and feet, a condition called peripheral neuropathy. You may feel stabbing pain, burning, or tingling sensations, but medications can help.

Skin

While most of the disease activity occurs deep inside your body, your skin can also reveal the presence of RA.

Nodules. About half the people with RA develop painless nodules, or lumps of tissue under the skin. They may come and go on their own, or with treatment with DMARDs.

Rashes. Inflammation of blood vessels (vasculitis) can cause red, bumpy skin rashes. In severe cases, vasculitis causes ulcers on the legs or under the nails. Controlling inflammation can both prevent and treat vasculitis-related skin rashes.

RA can cause bumps called nodules.

RA can cause bumps called nodules.

Medication effects. Minor skin concerns can be the result of medications for RA. For example, NSAIDs and methotrexate can cause it to be sensitive to the sun. Biologics, including those given by shot, can cause a skin reaction at the injection site.

Spine

Your neck, known as your cervical spine, is the third most common site for RA to attack. Besides discomfort, it can progress to a condition called cervical myelopathy. That’s when the joints in your cervical spine crowd the space in your spinal canal, putting pressure on your spinal cord. Severe cases can cause nerve-related problems like weakness, numbness, and loss of bowel or bladder control.

Wearing a neck collar support can make you more comfortable. Disease-modifying drugs can greatly reduce inflammation. But once there’s pressure on the spinal cord, you may need to explore surgery to give the spinal cord more space.

Reviewed By Michael Smith, MD, on October 7, 2021.

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