The earlier you begin medication treatment, the better your chances of halting joint damage, protecting your organs, and living a longer life without pain and disability, says Jonathan Greer, MD, a rheumatologist in Boynton Beach, Florida. Here’s everything you need to know to protect various parts of your body if you have RA.
The Eyes: How Rheumatoid Arthritis May Affect Them
Because of inflammation around the eyes, some people with rheumatoid arthritis may get either dry eye syndrome or episcleritis, a redness in the white part of the eye. These can generally be managed with over-the-counter or prescription drops. A more serious eye condition is scleritis, where a deeper part of the white area, the sclera, is affected. Untreated, scleritis can lead to vision loss. Uveitis can develop when the eye’s middle layer, the uvea, is inflamed. This brings on floaters (cobwebs or black spots in the field of vision), blurred vision, and pain, says Ana-Maria Orbai, MD, a rheumatologist and an assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore. RELATED: The Best Ways to Reduce Stress When You Have Rheumatoid Arthritis Untreated uveitis can put a person at risk of glaucoma, a disease that causes pressure to build up in the eye and can ultimately damage the optic nerve and cause blindness. (This can also happen from taking steroid medications for RA over a long period of time.) Treatment for both scleritis and uveitis involves corticosteroid eye drops. It’s also important to note that about 15 percent of people with RA develop another autoimmune disease, Sjögren’s syndrome (SS). This disease affects tear glands (as well as salivary glands), causing very dry eyes along with other symptoms. Because of the risk of these eye diseases, regular eye exams by an ophthalmologist are critical to diagnosing these conditions early, which is why everyone living with RA should see this specialist every year.
How Rheumatoid Arthritis May Affect Your Mouth
Research shows that people who have rheumatoid arthritis may be more likely to develop periodontal disease, which usually starts with a gum infection. They are also more likely to have dry mouth, which can predispose them to tooth decay. (This is especially true for people with coexisting SS.) The flip side of this may be true too: Poor oral health may lead to the onset or worsening of RA. Experts believe that inflammation in the mouth may stimulate the immune system, and in a people predisposed to RA the inflammation may trigger the body to start making antibodies associated with the disease. Researchers have been working to better understand the mechanism behind this, but the takeaway is that treating gum disease and preventing unnecessary gum infections is good for your RA, as well. Schedule frequent dental checkups to catch minor issues before they become major problems.
Rheumatoid Arthritis and Your Hands and Feet
Since RA is a condition of the joints, it’s obvious that it affects a person’s hands and feet. But beyond pain, RA can cause other distortions and deformities if it is not treated as early as possible with disease-modifying antirheumatic drugs (DMARDs). Some of the most common symptoms affecting the hands include locking joints, ulnar drift (weakening of tendons and ligaments that cause fingers to curve toward the pinkie), swan neck deformities (distortions of the joints causing unusual bending and straightening), and even ruptured tendons. All these effects can make basic life tasks such as writing, holding objects, and unscrewing lids difficult. The hands can also be affected by muscle cramping, which can be relieved by gentle movements and warm compresses. More concerning, the swelling of RA may put pressure on the median nerve (which runs from the wrist to the fingers), causing numbness or carpal tunnel syndrome. See your doctor if you experience any of these. In the feet, uncontrolled inflammation may lead to painful conditions like hammertoes (abnormal bending of the toes), bunion (a bony nodule on the outside edge of the big toe), pes planus (loosening of the arch joint in the middle of the foot), and valgus hind foot (loosening of the joint below the ankle, causing the foot to bend forward). RELATED: How to Relieve Rheumatoid Arthritis Related Foot Pain In addition to seeing your rheumatologist and, if necessary, a podiatrist, you may also consult an occupational or physical therapist. These experts help you learn ways of moving that are less painful and that strengthen muscles, says Rebecca Manno, MD, a rheumatologist and adjunct assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore.
Rashes, Ulcers, and Bumps: How RA Affects Your Skin
A skin rash or ulcers on the arms and legs sometimes occur in people with rheumatoid arthritis, especially if the disease has gone untreated for a long time, Dr. Greer says. Up to 30 percent of people with RA develop rheumatoid nodules — knots of inflammatory tissue just under the skin near a joint, according to research published in the journal Autoimmunity Reviews. Most often appearing on the elbows, hands, and feet, they can be treated with a steroid injection if they become bothersome. All the conditions that affect the skin tend to resolve once RA is controlled with DMARD medications.
How Rheumatoid Arthritis Can Hurt Your Heart
Higher levels of inflammation in people with rheumatoid arthritis increase the risk of heart disease, especially heart attacks and strokes, Greer says. These heart conditions can also be more fatal. In people with systemic inflammatory diseases like RA, heart attacks in those under 50 are twice as likely to be fatal as for people without an inflammatory condition, according to a study published in the European Journal of Preventive Cardiology in March 2021. To lower your risk, you’ll want to get your RA under control and also reduce heart risk factors, such as high blood pressure and high cholesterol. A healthy diet like the Mediterranean diet will lower your risk of heart disease. Another way to both assist your heart and improve your RA: Don’t smoke; and if you do smoke, quit as soon as possible; in addition, avoid exposure to secondhand smoke. Finally, know that certain RA medications themselves have been linked to heart problems; these side effects are rare, and are not a reason to skip drug treatment. “The negative effects of not treating RA with medication are much, much worse than the side effects of RA drugs,” cautions Greer.
Rheumatoid Arthritis and Your Lungs
The most common RA-related lung complication is interstitial lung disease (ILD), a condition that causes inflammation and scarring of the lung tissue. This illness can be hard to detect but occurs when lung tissue becomes inflamed and eventually scarred. It’s unclear exactly how many people with RA develop it, but French researchers presenting an abstract at the American College of Rheumatology (ACR) annual conference in November 2020 found that the prevalence of subclinical (symptomless) ILD was 18 percent in people who had RA for a dozen years. Other studies put the figure at over 50 percent. This scarring makes it harder for oxygen in the lungs to enter the bloodstream and travel to other organs. The condition can cause breathlessness and coughing, but it can also be asymptomatic. If untreated, it can progress to pulmonary fibrosis, in which tissues are permanently scarred. Research also shows that RA sufferers are at double the risk of chronic obstructive pulmonary disease, or COPD (also known as emphysema or chronic bronchitis), in which the air sacs can’t expand as easily and become clogged with mucus. There is no cure for COPD, although inhalers and steroids can help open airways. Pleurisy is another condition with increased risk. Here, the pleura — the tissue surrounding the lungs — becomes inflamed, which can lead to fluid buildup at the base of the lungs. People with RA may also develop nodules in the lungs, though they may not be bothered by them. (Nodules can also form on the throat and vocal cords, causing difficulty speaking.) Being proactive and diligent about your RA treatment can address inflammation and minimize the risk for lung problems. And of course, if you smoke, quit.
Rheumatoid Arthritis and Your Circulatory System: RA Can Trigger Anemia and Fatigue
A large percentage of people living with RA experience anemia, a shortage of red blood cells or the iron-rich hemoglobin in the red blood cells. Red blood cells carry oxygen from your lungs to all the cells in the body and organs, so when your organs aren’t getting enough O2, you can experience weakness, fatigue, headaches, shortness of breath, dizziness, and more. There are different types of anemia, and the most common type in RA patients is called anemia of inflammation and chronic disease (AI/ACD), explains rheumatologist Robert W. Lightfoot, MD, a professor of medicine in the division of rheumatology at the University of Kentucky College of Medicine in Lexington. No one knows exactly why anemia is more common with RA, but it may be that RA’s inflammatory molecules interfere with the body’s ability to use iron, which in turn leads to anemia. Iron supplementation can help, but the best treatment is keeping the inflammation of RA under control with DMARD medication. Another cause of fatigue: Inflammation can trigger the release of cytokines, molecules that are associated with fatigue. In addition, the depression and pain that can come along with RA can readily sap energy.
Rheumatoid Arthritis and Kidney Function: What to Know
Amyloidosis, a condition caused by the abnormal buildup of certain proteins that can impair kidney function, may occur in association with RA — usually in the later stages or if someone’s disease isn’t well-controlled with medication. The symptoms can be vague, such as weakness or swelling, and can include an enlarged spleen and gastrointestinal issues. To screen for amyloidosis, rheumatologists will periodically check your kidney function. To maintain healthy kidneys, you should also take care not to overuse nonsteroidal anti-inflammatory painkillers (NSAIDs), like ibuprofen and naproxen, as they can damage the kidneys, too.
Rheumatoid Arthritis Can Drain Your Brain and Mood
The fear that comes with living with any chronic illness, as well as dealing with daily pain and limited mobility, can take a toll on emotional wellness. But when it comes to RA, depression may be more than just an emotional response to the disease. “There is a clear link between RA and depression,” says Daniel Solomon, MD, MPH, the chief of the clinical sciences section in the division of rheumatology at Brigham and Women’s Hospital in Boston. “We don’t yet understand how much of the depression is from a reaction to the disease and how much is the inflammation of the disease, but they both contribute somehow.” What experts do know is that treating RA’s inflammation helps quell the inflammation associated with depression. The opposite may also be true: Treating depression (with talk therapy or medication, for example) may lessen the pain of the disease. According to research presented in early June 2021 at the annual congress of the European Alliance of Associations for Rheumatology (EULAR), catastrophizing about pain makes it worse, and it can actually physically impact the chances of RA remission.
How Rheumatoid Arthritis Threatens Bone Health
RA can increase your risk of osteoporosis, a disease in which bones become less dense and more fragile, increasing the likelihood they will break. The reason: The inflammation of RA accelerates the normal bone resorption — when bone tissue is broken down to release minerals into the blood — that leads to osteoporosis. Normally, the bone tissue that’s broken down gets replaced, but as we age, the rate of resorption exceeds the rate of new bone growth, reducing bone mass and setting the stage for osteoporosis. RA makes it even harder for bones to keep pace. The hip, forearm and pelvis are typical sites where breaks can occur, although breaks are more likely near the joints where the RA is active. Steroids, which are sometimes used to control RA, can especially speed bone loss. The best way to protect bones: Eat calcium-rich and vitamin D–rich foods like eggs and fish, as well as D-fortified foods; do weight-bearing exercises (walking, stair-stepping) that your doctor approves; if you smoke, quit; and get a bone mineral density test so your doctor can consider whether you need medication.
