Rheumatoid Arthritis Complications

heart on shirt illustration
Cardiovascular disease is the most common RA comorbidity.Canva; Everyday Health
Rheumatoid arthritis, which affects up to 3 times as many women as men, can also cause nonjoint-specific symptoms, including?fever, weight loss, and fatigue.

Left untreated,?RA?can lead to a number of complications or comorbidities (co-occurring conditions) throughout the body.

These complications and conditions may be more fatal to?people with RA?than those without. In fact, people with RA are nearly?twice as likely to succumb to health problems?like cancer and heart and respiratory conditions before age 75 than those without the disease, according to a 2018 study.

Rheumatoid Arthritis and Heart Disease Risk

People with RA often suffer from one or more additional conditions. Some of these comorbid conditions may be unrelated to RA, like certain cancers, but in other cases they may be directly or indirectly caused by RA,?RA treatment, or RA outcomes — such as decreased mobility and functional impairment, for example.

The most common and well-documented RA comorbidity is cardiovascular disease, in particular ischemic heart disease, in which there’s a reduced blood supply in the heart. People?with heart disease?are about twice as likely to also have RA compared with those who don’t have heart issues.

Rheumatoid arthritis is also associated with several specific cardiovascular issues, including?heart attack,?stroke,?congestive heart failure, peripheral vascular disease, and?atrial fibrillation.

?Research from 2015 found that people with RA are more likely to have?atherosclerosis?(buildup of fat, cholesterol, and plaque on blood vessel walls), and they develop it at a faster rate than the general population.

People with preclinical RA (a precursor condition to RA) aren’t safe from heart issues either. One study found that people with preclinical RA have a 24 percent increased risk of having a cardiovascular event over a 10-year period.

What’s more,?people with RA experience more severe acute coronary syndrome (ACS)?—?heart attack, unstable?angina, and other symptoms associated with sudden reduced blood flow to the heart — compared to the general population. A cohort study published in 2018 found that people with RA have 1.3 times the?risk of heart failure?compared with people without the disease.

The increased risk for ACS begins early in RA, too. A study from 2017?found that people newly diagnosed with RA have an approximately 40 percent increased risk of ACS compared with the general population.

RELATED:?Rheumatoid Arthritis and You: What RA Can Do to All Parts of the Body

And those RA patients who do survive ACS have a 30 percent increased risk of ACS recurrence and increased risk of death compared with the general population, according to a 2017 study.

?But treatment with RA medications called disease-modifying antirheumatic drugs (DMARDs) may improve the early stages of heart disease, according to a 2020 study.

For these reasons, it is important for people with RA to assess their cardiovascular disease risk factors, such as high blood pressure, diabetes, and smoking, and take steps to address them.

Other Health Conditions Related to Rheumatoid Arthritis

People with RA have an increased risk of infections that may be related to the immune system dysfunction associated with RA

?or to certain drugs that are used to treat the condition.

These drugs include corticosteroids, which reduce immune system activity and are the strongest contributors to serious infections in RA patients. Researchers reported in 2019 that people with RA had a 70 percent increased risk of serious infections compared with those with non-inflammatory rheumatic and musculoskeletal diseases — but that increased risk drops to 30 percent after controlling for corticosteroid use.

Infections account for about one-quarter of all RA-related deaths.

On the flip side,?research from 2015 suggested that recent?gastrointestinal?and?urinary tract infections?may reduce a person’s risk of developing RA by altering the microbiome (the microbial community of the body).

Malignancies associated with the lymphatic system, such as lymphoma, are also a risk for people with RA.

Additionally, RA affects the lungs and can cause RA-related lung disease. It’s estimated that 1 in 10 people with RA will develop interstitial lung disease.

?This disease accounts for 10 to 20 percent of all RA deaths.

RELATED: Protect Your Lung Health When You Have Rheumatoid Arthritis ?

Research from 2018 also found that people with asthma have 1.7 times the odds of people without asthma to have RA.

Rheumatoid Arthritis Complications

Complications are health issues that are caused by a condition or its treatment. The risk of complications from RA increases over time or when treatment is inadequate.

Over time, RA can cause more than just pain and inflammation in the joints — it can actually?deform joints, making it difficult for people to perform normal daily activities.

RA can cause inflammation to develop in other areas of the body, including:

  • Blood vessels, where it’s called rheumatoid?vasculitis?and can cause problems with the?skin, nerves, heart, and brain
  • Lungs, resulting in rheumatoid?lung disease or other conditions, such as pleurisy (swelling and scarring of lung tissue) or pulmonary nodules
  • Eyes, causing?Sj?gren’s syndrome, which interferes with tears and saliva production; and scleritis, which is marked by eye redness and pain
  • Heart, particularly the outer lining of the heart (pericarditis) and heart muscle (myocarditis)
  • Wrists, causing?carpal tunnel syndrome, in which pressure on the nerves of the hand results in?numbness, tingling, and difficulty using the hands and fingers

Numerous other complications are also possible, including:

  • Peripheral?neuropathy, a dysfunction of nerves that results in nerve pain, numbness, and tingling, particularly in the hands and feet
  • Muscle weakness
  • Anemia, a decreased red blood cell count that increases fatigue and weakness
  • Various skin conditions, such as blisters,?rashes,?ulcers, lumps under the skin

  • Osteoporosis, or low bone density
  • Spinal injuries (when neck bones are damaged from inflammation)
  • Periodontal (gum) disease, though some research suggests this disease precedes RA, and other research suggests?some cases of RA may be caused by the same bacteria behind gum disease.

  • Kidney impairment caused by?RA medication
  • Enlargement of the spleen (Felty?syndrome)
  • Pregnancy complications, such as increased risk of premature delivery

Mental Health and Cognitive Issues Related to Rheumatoid Arthritis

Mental health conditions like?anxiety,?depression, and bipolar disorder are not uncommon among people with arthritis, RA included.

For example, in a study from 2018, researchers found that 55 percent of adults age 50 or older who had minor depression also had arthritis. Those rates jumped to 62.9 percent and 67.8 percent for geriatric arthritis patients?experiencing moderate and severe depression, respectively.

Research presented in 2019 showed a similar?link between arthritis and mental health issues. In one study, researchers found that 10 percent of patients with?rheumatic?and musculoskeletal diseases surveyed had suicidal thoughts. Another study found that 25 percent of patients with RA or adult juvenile idiopathic arthritis experienced anxiety or depression.

Study participants also noted marked?sleeping issues due to pain.

Researchers have also investigated the link between mental health issues and RA, specifically. A 2018 study found that the incidence of depression, anxiety, and bipolar disorder was higher in people with RA than those without RA by 45 percent, 25 percent, and 20 percent, respectively.

There is also some evidence that having?RA increases the risk of dementia. People with RA may have a 61 percent increased risk of?dementia?compared with the general population, according to a?review from 2016.

Another study a year later?suggested that the commonly used DMARD drugs may play a role in the development of dementia.

?Yet, biologic or targeted synthetic DMARDs may decrease the risk of dementia by 17 percent compared with conventional DMARDs, according to research presented in 2020.

More research is needed, however, as other studies have shown conflicting results, including a decreased risk of?Alzheimer’s disease?for RA patients (dementia is a?symptom of Alzheimer’s disease)

?and a reduced risk of dementia for patients using DMARDs.

Does Rheumatoid Arthritis Cause Cancer?

People with RA are known to have an increased risk of lymphomas (cancer of the lymph nodes), particularly?non-Hodgkin?lymphoma. The overall incidence of lymphomas among people with RA is almost twice as high as in the general population, research shows.

Studies have suggested that newer versions of DMARDs, called biologic DMARDs, may be partly to blame. But a large study from 2017 showed that?RA treatment doesn’t affect lymphoma risk.

A Swedish cohort study reported in 2021 that biologic DMARDs do not further increase lymphoma risk in RA patients. In fact, the drugs may actually reduce “excess lymphoma risk,” the researchers noted.

As is the case with many other RA comorbidities and complications, the increased?lymphoma risk?is likely the result of uncontrolled RA inflammation, the research suggested.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. Prevalence of Rheumatoid Arthritis in the United States Adult Population in Healthcare Claims Databases, 2004–2014. Rheumatology International.
  2. Rheumatoid Arthritis (RA). Centers for Disease Control and Prevention.
  3. Causes of Death in Rheumatoid Arthritis: How Do They Compare to the General Population? Arthritis Care & Research.
  4. Arthritis: Comorbidities. Centers for Disease Control and Prevention.
  5. Rheumatoid Arthritis and Heart Disease. Arthritis Foundation.
  6. Atherosclerosis in Rheumatoid Arthritis: Is It All About Inflammation? Nature Reviews Rheumatology.
  7. Autoantibodies and the Risk of Cardiovascular Events. The Journal of Rheumatology.
  8. Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study. Journal of the American Heart Association.
  9. Acute Coronary Syndrome in New-Onset Rheumatoid Arthritis: A Population-Based Nationwide Cohort Study of Time Trends in Risks and Excess Risks. Annals of the Rheumatic Diseases.
  10. Long-Term Outcomes and Secondary Prevention After Acute Coronary Events in Patients With Rheumatoid Arthritis. Annals of the Rheumatic Diseases.
  11. Cardiovascular Effects of Biological Versus Conventional Synthetic Disease-Modifying Antirheumatic Drug Therapy in Treatment-Na?ve, Early Rheumatoid Arthritis. Annals of the Rheumatic Diseases.
  12. Arthritis and Infection Risk. Arthritis Foundation.
  13. Infections in Rheumatoid Arthritis. Current Opinion in Rheumatology.
  14. Serious Infection Risk in Rheumatoid Arthritis Compared With Non-Inflammatory Rheumatic and Musculoskeletal Diseases: A U.S. National Cohort Study. RMD Open.
  15. Rheumatoid Arthritis. Johns Hopkins Arthritis Center.
  16. Recent Infections Are Associated With Decreased Risk of Rheumatoid Arthritis: A Population-Based Case-Control Study. Annals of the Rheumatic Diseases.
  17. What You Need to Know About RA and Lung Disease. Arthritis Foundation.
  18. Association of Asthma With Rheumatoid Arthritis: A Population-Based Case-Control Study. The Journal of Allergy and Clinical Immunology: In Practice.
  19. Rheumatoid Arthritis. MedlinePlus.
  20. Aggregatibacter Actinomycetemcomitans–Induced Hypercitrullination Links Periodontal Infection to Autoimmunity in Rheumatoid Arthritis. Science Translational Medicine.
  21. Rheumatoid Arthritis and Pregnancy. UpToDate.
  22. Prevalence Rates of Arthritis Among U.S. Older Adults With Varying Degrees of Depression: Findings From the 2011 to 2014 National Health and Nutrition Examination Survey. International Journal of Geriatric Psychiatry.
  23. The Influence of Pain on Sleep Problems, Mental Health and Use of Strong Painkillers Among Patients With Arthritis. Annals of the Rheumatic Diseases.
  24. Increased Burden of Psychiatric Disorders in Rheumatoid Arthritis. Arthritis Care & Research.
  25. Rheumatoid Arthritis and the Risk of Dementia: A Systematic Review and Meta-Analysis. Neurology India.
  26. DMARD Use Is Associated With a Higher Risk of Dementia in Patients With Rheumatoid Arthritis: A Propensity Score-Matched Case-Control Study. Toxicology and Applied Pharmacology.
  27. Incidence of Dementia in Patients With Rheumatoid Arthritis and Association With DMARDs — Analysis of a National Claims Database. American College of Rheumatology: Meeting Abstracts.
  28. Rheumatoid Arthritis and Risk for Alzheimer’s Disease: A Systematic Review and Meta-Analysis and a Mendelian Randomization Study. Scientific Reports.
  29. Protective Effect of Antirheumatic Drugs on Dementia in Rheumatoid Arthritis Patients. Alzheimer’s & Dementia: Translational Research & Clinical Interventions.
  30. Spectrum of Lymphomas Across Different Drug Treatment Groups in Rheumatoid Arthritis: A European Registries Collaborative Project. Annals of the Rheumatic Diseases.
  31. Lymphoma Risks in Patients With Rheumatoid Arthritis Treated With Biological Drugs — a Swedish Cohort Study of Risks by Time, Drug and Lymphoma Subtype. Rheumatology.

Resources

  • Hunter TM, Boytsov NN, Zhang X, et al. Prevalence of Rheumatoid Arthritis in the United States Adult Population in Healthcare Claims Databases, 2004–2014.?Rheumatology International.?September 2017.
  • Rheumatoid Arthritis (RA).?Centers for Disease Control and Prevention. July 27, 2020.
  • Widdifield J, Paterson JM, Huang A, Bernatsky S. Causes of Death in Rheumatoid Arthritis: How Do They Compare to the General Population??Arthritis Care & Research. December 2018.
  • Arthritis: Comorbidities.?Centers for Disease Control and Prevention. August 4, 2022.
  • Rheumatoid Arthritis and Heart Disease.?Arthritis Foundation.?February 11, 2022.
  • Skeoch S, Bruce IN.?Atherosclerosis in Rheumatoid Arthritis: Is It All About Inflammation??Nature Reviews Rheumatology. July 2015.
  • Liang KP, Maradit-Kremers H, Crowson CS, et al. Autoantibodies?and the Risk of Cardiovascular Events. The Journal of?Rheumatology. November 2009.
  • Khalid?U, Egeberg?A, Ahlehoff?O, et al. Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study.?Journal of the American Heart Association. January 23, 2018.
  • Holmqvist M, Ljung L, Askling, J, et al.?Acute Coronary Syndrome in New-Onset Rheumatoid Arthritis: A Population-Based Nationwide Cohort Study of Time Trends in Risks and Excess Risks. Annals of the Rheumatic Diseases. October 2017.
  • Mantel ?,?Holmqvist?M,?Jernberg?T, et al.?Long-Term Outcomes and Secondary Prevention After Acute Coronary Events in Patients With Rheumatoid Arthritis. Annals of the Rheumatic Diseases. December 2017.
  • Arthritis and Infection Risk.?Arthritis Foundation.
  • Atzeni?F,?Masala?IF, di Franco M,?Sarzi-Puttini?P. Infections in Rheumatoid Arthritis.?Current Opinion in?Rheumatology. July 2017.
  • Mehta B, Pedro S, Ozen G, et al.?Serious Infection Risk in Rheumatoid Arthritis Compared With Non-inflammatory Rheumatic and Musculoskeletal Diseases: A U.S. National Cohort Study. RMD Open. June 9, 2019.
  • Rheumatoid Arthritis.?Johns Hopkins Arthritis Center.
  • Rheumatoid Arthritis.?MedlinePlus. January 16, 2022.
  • Konig MF, Abusleme L, Reinholdt J, et al.?Aggregatibacter Actinomycetemcomitans–induced Hypercitrullination Links Periodontal Infection to Autoimmunity in Rheumatoid Arthritis. Science Translational Medicine. December 14, 2016.
  • Bermas BL. Patient Education: Rheumatoid Arthritis and Pregnancy (Beyond the Basics).?UpToDate. March 7, 2022.
  • Sandberg MEC, Bengtsson C, Klareskog L, et al. Recent Infections Are Associated With Decreased Risk of Rheumatoid Arthritis: A Population-Based Case-Control Study.?Annals of the Rheumatic Diseases. February 5, 2015.
  • What You Need to Know About RA and Lung Disease.?Arthritis Foundation.
  • Plein S, Erhayiem B, Fent G, et al.?Cardiovascular Effects of Biological Versus Conventional Synthetic Disease-Modifying Antirheumatic Drug Therapy in Treatment-Na?ve, Early Rheumatoid Arthritis. Annals of the Rheumatic Diseases. August 28, 2020.
  • Sheen YH, Rolfes MC, Wi CI, et al.?Association of Asthma With Rheumatoid Arthritis: A Population-Based Case-Control Study. The Journal of Allergy and Clinical Immunology: In Practice. January–February 2018.
  • Brooks JM, Titus AJ,?Polenick?CA, et al. Prevalence Rates of Arthritis Among U.S. Older Adults With Varying Degrees of Depression: Findings From the 2011 to 2014 National Health and Nutrition Examination Survey.?International Journal of Geriatric Psychiatry. December 2018.
  • Thomsen LM. The Influence of Pain on Sleep Problems, Mental Health and Use of Strong Painkillers Among Patients With Arthritis. Annals of the Rheumatic Diseases. June 15, 2019.
  • Marrie RA, Hitchon CA, Walld R, et al.?Increased Burden of Psychiatric Disorders in Rheumatoid Arthritis. Arthritis Care & Research. July 2018.
  • Ungprasert P, Wijarnpreecha K, Thongprayoon C. Rheumatoid Arthritis and the Risk of Dementia: A Systematic Review and Meta-Analysis.?Neurology India. January 11, 2016.
  • Chou M-H, Wang J-Y, Lin C-L, Chung W-S. DMARD Use Is Associated With a Higher Risk of Dementia in Patients With Rheumatoid Arthritis: A Propensity Score-Matched Case-Control Study.?Toxicology and Applied Pharmacology. November 2017.
  • Sattui S, Navarro-Millan I, Xie F,?et al. Incidence of Dementia in Patients With Rheumatoid Arthritis and Association With DMARDs — Analysis of a National Claims Database. American College of Rheumatology: Meeting Abstracts. November 6, 2020.
  • Policicchio?S, Ahmad AN, Powell JF,?Proitsi?P. Rheumatoid Arthritis and Risk for Alzheimer’s Disease: A Systematic Review and Meta-Analysis and a?Mendelian?Randomization Study.?Scientific Reports. October 9, 2017.
  • Judge A,?Garriga?C, Arden NK, et al. Protective Effect of?Antirheumatic?Drugs on Dementia in Rheumatoid Arthritis Patients.?Alzheimer’s & Dementia: Translational Research & Clinical Interventions. November 13, 2017.
  • Mercer LK, Regierer?AC, Mariette X, et al.?Spectrum of Lymphomas Across Different Drug Treatment Groups in Rheumatoid Arthritis: A European Registries Collaborative Project. Annals of the Rheumatic Diseases. December, 2017.
  • Hellgren H, Di Giuseppe D, Smedby KE, et al.?Lymphoma Risks in Patients With Rheumatoid Arthritis Treated With Biological Drugs — a Swedish Cohort Study of Risks by Time, Drug and Lymphoma Subtype. Rheumatology. February 2021.
Show Less
xxfseo.com