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Beyond Joints: How RA Affects the Body

There’s no denying that RA affects your joints. But did you know that other parts of your body may also be battling the effects of RA in ways you might not even notice? "It is important to know that RA is actually a systemic disease,” says Kevin Deane, MD, associate professor of medicine in the Division of Rheumatology at the University of Colorado School of Medicine in Aurora. “The antibodies, autoimmune cells and inflammation that are related to the disease go everywhere. They certainly affect the joints and cause inflammation, but they can attack anywhere and basically affect any part of the body.”

In addition, people with RA often have "comorbidities,” other diseases that tend to occur together for reasons that are not well understood. Regular medical check-ups can forestall comorbidities, and disease-modifying  drugs have made the so-called extra-articular, systemic effects of RA far less common than they once were. “The problem is people focus on their joints and forget about these other things, but they need to think about them,” Dr. Deane says.

Here’s a look at where in the body RA can have an effect, and how.

Lungs. Most people with RA have some lung involvement that generally isn’t severe enough to cause symptoms. However, in some cases it can lead to interstitial lung disease, characterized by inflammation
and scarring of lung tissue that interferes with breathing and can be difficult to treat.

Lymph system. People with RA are two to three times more likely than those without RA to develop lymphoma, a cancer of this part of the immune system, but because lymphoma is rare, the risk of developing it is low. It is unclear if the increased risk is from the RA or the immune-suppressing drugs used to treat it.

Eyes. RA can lead to scleritis, inflammation and scarring of the whites of the eyes. People with RA can also develop an autoimmune condition called Sjögren’s syndrome, in which the immune system attacks moisture-producing glands, resulting in severe dry eye and dysfunction of other organs.

Bone. Chronic inflammation leads to loss of bone density and possible osteoporosis throughout the body. Long-term use and high doses of corticosteroids also can cause bone thinning.

Brain. Depression and anxiety are more common in people with RA than in the general population. It is not clear whether they result from struggling with the pain and disability of RA or whether they are part of the autoimmune disease process.

Mouth. Almost 65 percent of people with RA have gum (periodontal) disease, according to a 2012 study published in the Annals of the Rheumatic Diseases. If untreated, it can result in tooth loss and major damage to the bone that supports the teeth. Dry mouth associated with Sjögren’s syndrome can lead to cavities, mouth sores and other problems.

Heart and blood vessels (cardiovascular system). People with RA have an increased risk of cardiovascular disease. Chronic inflammation can damage endothelial cells that line the blood vessels, leading to premature atherosclerosis. A 2010 study found the risk of heart attack was 60 percent higher in people with RA just one year after diagnosis.

Kidneys. People with RA are 5 percent more likely than others to develop kidney disease, a gradual loss of kidney function that can lead to kidney failure.

Less commonly, RA can affect other body parts, resulting in:

  • skin rashes due to blood vessel inflammation
  • nerve damage or compression of a nerve by inflamed tissue
  • blood changes, such as a decrease in red blood cells, resulting in anemia (your blood does not carry enough oxygen to the rest of your body)
  • inflamed spleen (an organ that does many important things, such as help you fight infection and help your blood clot)
  • low white blood cell count making it difficult for the body to battle the inflammation (a condition called Felty’s syndrome)