Complications of rheumatoid arthritis

 Rheumatoid Arthritis (RA) is a disease of young adults. Regrettably, RA has very little identity of its own. Anything with “arthritis” is considered to be linked with old age. Adding the prefix “rheumatoid” frequently adds little additional impact. The average individual has very little knowledge of rheumatic diseases. Many patients face complications of rheumatoid arthritis due to late diagnosis and high delay in the treatment initiation.

Joint damage

RA has potential to cause progressive and permanent damage.

Problems that can affect the joints include:

·       damage to nearby bone and cartilage (a tough, flexible material that covers the surface of joints)

·       damage to nearby tendons (flexible tissue that attach muscle to bone), which could cause them to break (rupture)

·       deformities in joints leading to change in normal shape and appearance

Many patients need surgical treatment to relieve pain and improve function loss caused by untreated disease.

Inflammation in internal organs

RA is not a disease of only joints. It can affect other organs like eye, lungs and heart.

Lungs – inflammation of the lungs or lung lining can lead to pleurisy or Interstitial lung diseases/pulmonary fibrosis, which can cause chest pain, a persistent cough and shortness of breath.

Heart – inflammation of the tissue around the heart can lead to pericarditis, which causes chest pain.

Eyes – inflammation of the eyes can lead to redness, pain, dryness and reduced vision. It can cause scleritis or Sjögren's syndrome.

Blood vessels – inflammation of the blood vessels (vasculitis) is a life-threatening condition.  It can affect blood flow to your body's organs and tissues.

However, with early treatment, inflammation in other parts of the body from rheumatoid arthritis is less likely.

Cardiovascular disease

If you have rheumatoid arthritis, you're at a higher risk of developing cardiovascular disease (CVD). Patients with rheumatoid arthritis (RA) die at a younger age. The incidence of heart attacks is much higher in patients with RA. Just like high cholesterol, diabetes and hypertension - RA is a separate risk factor for heart disease. The risk of heart attack for RA patients is comparable to those with type 2 diabetes.

 Effects on the Skin

You might develop lumps of soft tissue called rheumatoid nodules. They usually appear on your skin, especially on the elbows, forearms, heels, or fingers. Sometimes, inflammation of blood vessels -vasculitis - shows up as spots on the skin which may even cause deep ulcers on the skin.

 Osteoporosis (weak bones)

Rheumatoid arthritis itself can increase your risk of osteoporosis — a condition that weakens your bones and makes them more prone to fracture. In addition to rheumatoid arthritis, increasing age and certain medications like steroids can also make your bones weak.

Carpal tunnel syndrome

Carpal tunnel syndrome describes a condition in which a nerve that passes through your wrist’s bony tunnel gets compressed. The inflammation from active rheumatoid arthritis at the wrist can compress the nerve causing carpal tunnel syndrome. You may experience numbness or tingling sensation in your hand and fingers.

 

What Can I Do To Reduce My Risk of Developing Complications?

 

1.   If you have developed RA related complications you might need different doctors and different treatments to control your RA. Always discuss new symptoms with your doctor.

 

2.   Patients with untreated or poorly controlled RA are at higher risk of getting complications and internal organ involvement. Early treatment with disease modifying anti-rheumatic drugs (DMARDs) aiming for complete control of disease activity within the first year of disease is required.

 

3.   Following changes may help to reduce your risk of heart disease and give you a greater sense of well-being.

 

4.   Quit smoking.

 

5.   Decrease sugar and salt intake.

 

6.   Avoid processed foods containing trans fats.

 

7.   Be active often. Research shows that 30 minutes of exercise five days a week can lower blood pressure, cholesterol levels and risk of heart attacks.

 

8.   Being overweight and obese are major risk factors heart disease. Losing weight can reduce the risk.

 

9.   Appropriate treatment of RA can protect patients from developing heart problems and such therapy to be commenced early in the disease.

 

10.  Do not stop medications abruptly. It is important to continue medications even when your arthritis symptoms are under control. Regular medications with appropriate monitoring helps to prevent RA related complications in other organs.

 

11.  Do not miss your follow up appointment. Regular follow up with rheumatologist can help to spot potential complications at an early stage.

 

12. Pay attention your bone health. Regular calcium and vitamin D supplements can help to make your bones strong and prevent osteoporosis. You may need tests like DEXA scan to measure osteoporosis.