Beyond Joints: How RA Affects the Body
Rheumatoid arthritis is a condition that affects the joints, lungs and other parts of the body.
Rheumatoid arthritis (RA) makes your joints stiff and achy, but it doesn't always stop there.
"RA is a joint condition, but it can cause other problems," says rheumatologist Sadia Khan, MD, of Mercy Hospital in Baltimore. For instance, you may struggle with fatigue, too.
The good news: Reining in joint symptoms by adopting a solid treatment plan drastically lowers your risk for these 10 related conditions.
Cardiovascular Disease: Having RA not only increases your risk for heart attacks (by 68%) and stroke (by about 65%), but it also ups the chances that cardiovascular problems will strike at a younger age. The problem: Unchecked inflammation is a major contributor to artherosclerosis, or artery blockages that can cut off blood flow to the heart and brain. People with RA are also at increased risk for pericarditis, or inflammation of the tissue surrounding the heart, which can cause chest pain and other symptoms and may be fatal. However, recent research suggests that effective treatments for RA also lower the risk for cardiovascular disease.
Lung Disease: Inflammation can attack the lining of your lungs, leaving permanent scarring that causes shortness of breath. This condition called interstitial lung disease (ILD), affects up to 10 percent of people with RA. However, not all breathing difficulties are disease-related; methotrexate has been linked to lung problems, too, notes Dr. Khan. So, if you develop problems breathing and you use this medication for your RA, switching to a different treatment may be necessary.,
Fibromyalgia: Close to half of people with RA have fibromyalgia, says rheumatologist Ali Ajam, MD, of The Ohio State University Wexner Medical Center in Columbus. "The symptoms of fibromyalgia can be similar to arthritis symptoms, but the pain is more likely to affect your muscles," he explains. In people who develop fibromyalgia, the brain produces substances that increase the perception of pain, says Dr. Ajam. The central nervous system may also process pain signals differently. Your RA meds won't ease fibromyalgia symptoms, so if you ache for no obvious reason, tell your doctor so you can get the right treatment.
Osteoporosis: Having RA can be a double whammy for your bones, says Dr. Khan. The corticosteroids often prescribed for managing flares weaken your skeleton, while fatigue and pain can keep you on the sofa instead of walking, jogging or doing other weight-bearing exercises, which strengthen bones. Loss of bone density can set you up for a fracture. If you're a post-menopausal woman or you have used corticosteroids, get screened for osteoporosis.
Eye problems: Better treatments have reduced the risk for certain eye problems that used to occur commonly with RA, says Dr. Khan. However, she still sees a significant number of patients who have uveitis - inflammation of the uvea, the middle layer of the eye - which can cause redness, blurred vision, floaters and other symptoms. Fortunately, medications that control joint symptoms usually control uveitis.
Certain Cancers: Changes in the immune system that occur in people with RA double the risk for lymphoma, a cancer of the blood. The worse your symptoms are, the higher your risk for lymphoma. Lung cancer is more common, too. And using methotrexate or a biologic drug slightly increases the risk for two (highly treatable) forms of skin cancer, basal cell carcinoma and squamous cell carcinoma. So, slather on sun block when you venture outdoors, and show your doctor any unusual skin changes.
Gum Disease: Having RA doubles your risk for periodontal disease, which can cause swollen gums, tooth loss and other symptoms. Conversely, studies suggest that having periodontal disease can set the stage for developing RA. A common culprit is runaway inflammation, which can damage the gums. Count this as a reason to brush and floss religiously and to see your dentist for regular checkups and cleanings.
Sleep Problems: More than half of RA patients struggle to get a good night's rest, according to a 2018 survey in the Journal of Clinical Medicine. If you're not getting restorative shut-eye, says Dr. Ajam, "you'll have more pain in general." More pain may make it even harder to sleep, resulting in a vicious cycle. Poor sleep is also a leading contributor to daytime fatigue. Adopt good "sleep hygiene," such as going to bed and getting up at the same times every day and keeping your bedroom dark and cool.
Depression: It's nosurprise that living with a chronic, painful condition can leave you feeling down much of the time, either because of the effects of the disease itself or because depression may be related to the inflammation that causes RA. "Having RA can lead to depression, typically in people who don't have a good handle on the disease," says Dr. Khan. This mood disorder may be unrelated to RA, she adds, but when it is linked to the disease, depression often eases once you get an effective treatment plan in place.
Gout: Doctors used to think that gout was rare in people with RA, but a 2017 study in the journal Clinical Rheumatology found that people with RA are 61 percent more likely than others to develop this painful form of inflmmatory arthritis, which often afflicts the big toe (but can also occur in other joints). Scientists are still sorting out the link between gout and RA, but let your doctor know if you have a throbbing toe or other joints even when taking your meds as instructed.