How Rheumatoid Arthritis Affects More Than Joints

Nodules: About half of people with RA develop rheumatoid nodules. These are lumps of tissue that form under the skin, often over bony areas exposed to pressure, such as fingers or elbows. Unless the nodule is located in a sensitive spot, such as where you hold a pen, treatment may not be necessary. Nodules sometimes disappear on their own or with treatment with disease-modifying antirheumatic drugs (DMARDs).

Rashes: When RA-related inflammation of the blood vessels (called vasculitis) affects the skin, a rash of small red dots is the result. In more severe cases, vasculitis can cause skin ulcers on the legs or under the nails. Controlling the rash or ulcers requires controlling the underlying inflammation.

Drug effects: Corticosteroids, prescribed to reduce inflammation, can cause thinning of the skin and susceptibility to bruising. Non-steroidal anti-inflammatory drugs (NSAIDs), which treat pain and inflammation, and methotrexate, a widely prescribed DMARD, can cause sun sensitivity. People taking biologics, a sub-category of DMARDs designed to stop inflammation at the cellular level, may develop a rash at the injection site.
 

Thinning: Chronic inflammation from RA leads to loss of bone density, not only around the joints, but throughout the body, leading to thin, brittle bones. Exercise, a high-calcium diet and vitamin D can all help bones, but in some cases your doctor may need to prescribe a drug to stimulate bone growth or prevent bone loss.

Drug effects: Corticosteroids can also cause bone thinning.

Inflammation and scarring: Some people with RA develop inflammation of the whites of the eyes (scleritis) that can lead to scarring. Symptoms include pain, redness, blurred vision and light sensitivity. Scleritis is usually treatable with medications prescribed by your doctor, but in rare cases, the eye may be permanently damaged. RA can also cause uveitis, an inflammation of the area between the retina and the white of the eye, which, if not treated, could cause blindness.

Dryness: The inflammatory process that affects the joints can also damage the tear-producing glands, a condition known as Sjögren’s syndrome. The result is eyes that feel dry and gritty. Artificial tears, which are available over the counter, as well as medications your doctor prescribes, can keep eyes more comfortable and help prevent damage related to dryness.

Drug effects: Corticosteroids may cause glaucoma and cataracts. Hydroxychloroquine, in rare cases, causes pigment changes in the retina that can lead to vision loss. As a rule, people with RA should get eye checkups at least once a year.

Dryness: Inflammation can damage the moisture-producing glands of the mouth as well as the eyes, resulting in a dry mouth. Over-the-counter artificial saliva products and self-treatment often helps. If not, your doctor may prescribe a medication to increase the production of saliva. Good dental hygiene is a must, as bacteria tend to flourish in a dry mouth, leading to tooth decay and gum disease.

Drug effects: Methotrexate can cause mouth sores or oral ulcers. For treatment, try a topical pain reliever or ask your doctor or dentist for a prescription mouthwash.

Inflammation and scarring: Up to 80% of people with RA have some degree of lung involvement, which is usually not severe enough to cause symptoms. However, severe, prolonged inflammation of the lung tissue can lead to a form of lung disease called pulmonary fibrosis that interferes with breathing and can be difficult to treat.

Nodules: Rheumatoid nodules might form in the lungs but are usually harmless.

Drug effects: Methotrexate can cause a complication known as methotrexate lung or methotrexate pneumonia, which generally goes away when the methotrexate is stopped. Less common drugs, including injectable gold and penicillamine, can cause similar pneumonias. The condition goes away when treatment ceases; patients can usually resume the drug in a few weeks.

By suppressing your immune system, corticosteroids, DMARDs and biologics may increase your risk of tuberculosis (TB), a bacterial infection of the lungs. Your doctor should test for TB before initiating treatment and periodically after.

Atherosclerosis: Chronic inflammation can damage endothelial cells that line the blood vessels, causing the vessels to absorb more cholesterol and form plaques.

Heart attack and stroke: When plaques from damaged blood vessels break lose, they can block a vessel, leading to heart attack or stroke. In fact, a 2010 Swedish study found that the risk of heart attack for people with RA was 60% higher just one year after being diagnosed with RA.

Pericarditis: Inflammation of the heart lining, the pericardium, may manifest as chest pain. Treatment to control arthritis often controls pericarditis as well.

Drug effects: While many RA medications, including methotrexate, other DMARDs and biologics may reduce cardiovascular risk in people with RA, other medications — chiefly NSAIDs — may increase the risk of cardiovascular events including heart attack. Your doctor will need to evaluate your risk when prescribing treatment for your RA.

Drug effects: Although RA doesn’t directly harm the liver, some medications taken for RA can. For example, long-term use of the pain reliever acetaminophen (Tylenol) is considered a leading cause of liver failure. Liver diseases may also occur with long-term methotrexate use. Working with your rheumatologist to monitor your blood is key to preventing problems.

Drug effects: As with the liver, drugs taken for arthritis can lead to kidney problems. The most common offenders include cyclosporine, methotrexate and NSAIDs. If you are taking these drugs long term, your doctor will monitor your kidney function to watch for problems.

Anemia: Unchecked inflammation can lead to a reduction in red blood cells characterized by headache and fatigue. Treatment consists of drugs to control inflammation along with iron supplements.

Blood clots: Inflammation might lead to elevated blood platelet levels, and blood clots.

Felty syndrome: Though rare, people with longstanding RA can develop Felty syndrome, characterized by an enlarged spleen and low white blood cell count. This condition may lead to increased risk of infection and lymphoma (cancer of the lymph glands). Immunosuppressant drugs are the usual treatment.

Drug effects: Aggressively treating inflammation with corticosteroids may cause thrombocytopenia, an abnormally low number of blood platelets.