How Rheumatoid Arthritis Affects More Than Joints
Learn more about how the inflammation associated with RA can impact organs and systems beyond the joints.
Arthritis can cause painful, swollen knees or fingers that are impossible to ignore. But other parts of the body, including the skin, eyes and lungs can also be affected. Rheumatoid arthritis (RA) is a systemic disease, meaning it can affect many parts of the body.
In addition, the drugs used to treat RA can also cause health problems. Many of these problems — such as bone thinning or changes in kidney function — cause no immediate symptoms so your doctor may monitor you through lab tests or checkups. For other problems — such as skin rashes or dry mouth — it’s important to report any symptoms to your doctor, who can determine the cause, and adjust your treatments accordingly.
It’s important to be aware of the affected areas of the body and side effects you may experience. This way, early aggressive treatment can help you avoid RA-related health issues.
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.
Drug effects: Corticosteroids can also cause bone thinning.
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.
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.
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.
Heart and Blood Vessels
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.
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.
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