How Rheumatoid Arthritis Affects the Whole Body

Rheumatoid arthritis (RA), an autoimmune inflammatory condition that causes pain, stiffness, and swelling, is most noted for its effects on the body’s joints. But rheumatoid arthritis is also a systemic disease, meaning it can affect the whole body, damage major organs, and even lead to a shortened life span.

The earlier you begin medication, 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.

How Rheumatoid Arthritis Can Affect Your Eyes

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, according to Johns Hopkins Medicine.

A more serious eye condition is scleritis, in which 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.

Untreated uveitis can put a person at risk of glaucoma, a disease that causes pressure to build up in the eye that can ultimately damage the optic nerve and cause blindness. (This can also happen to people who take steroid medications for RA over a long period of time.) Treatment for both scleritis and uveitis involves corticosteroid eye drops, though this may not be enough to treat uveitis beyond the front of the eye, in which case oral and injected corticosteroids may be needed, according to the Mayo Clinic.

It’s also important to note that up to 30 percent of people with RA develop another autoimmune disease, Sjögren’s syndrome. 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.

RELATED: Rheumatoid Arthritis and Your Eyes: What to Know

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 Sjögren’s syndrome.)

The flip side of this may be true too: Poor oral health may lead to the onset or worsening of RA. Evidence suggests that bacteria in the mouth create autoantibodies that can attack the lining of the joints; according to the Arthritis Foundation, damaged gum tissue allows these bacteria to travel from the mouth into the bloodstream and affect other parts of the body.

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. Some rheumatologists recommend a visit every three months, instead of the usual six, if you can afford it or your insurance covers it.

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 joint 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 deviation (also called ulnar drift — a 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, according to research published in the European Journal of Orthopaedic Surgery and Traumatology in 2020. 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 inflammation of RA can affect the median nerve (which runs from the wrist to the fingers), causing numbness or carpal tunnel syndrome, notes CreakyJoints. 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), a collapsed arch, and flatfoot deformity, notes the American Academy of Orthopaedic Surgeons.

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 25 percent of people with RA develop rheumatoid nodules — knots of inflammatory tissue just under the skin near a joint. Most often appearing on the elbows, hands, and feet, they can be treated with a steroid injection if they become bothersome.

The conditions that affect the skin tend to resolve once RA is controlled with DMARD medications.

Rheumatoid Arthritis and Your Heart and Circulatory System

Higher levels of inflammation in people with rheumatoid arthritis increase the risk of heart disease, especially heart attacks and strokes, Greer says. Inflammation increases the buildup of plaque in the arteries, which narrows blood vessels and slows blood flow, notes the Arthritis Foundation, upping the chances of stroke and heart attack.

These heart conditions are also more deadly in those with RA. In people with systemic inflammatory diseases, heart attacks in those under 50 were found to be twice as likely to be fatal compared with heart attacks in 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 can lower your risk of heart disease.

Another way to 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 – including NSAIDs and steroids, per the Arthritis Foundation – have been linked to heart problems; JAK inhibitors may raise cholesterol levels, notes CreakyJoints. But these side effects are 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.

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 a common type in RA patients is called anemia of chronic disease. RA’s inflammatory molecules may interfere with the body’s ability to use iron, which in turn leads to anemia. Iron supplementation can help, but the best treatment is to keep the inflammation of RA under control with DMARD medication.

Another cause of fatigue: Autoimmune disorders like RA can trigger the release of inflammatory cytokines (proteins) in the blood, and the body undergoes stress as it tries to manage this, which leads to fatigue, notes the Arthritis Foundation. In addition, the depression and pain that may come along with RA continually sap energy.

RELATED: The Link Between Rheumatoid Arthritis and Anemia

Fever: A Full-Body Effect of Rheumatoid Arthritis

According to the American College of Rheumatology, low-grade fever is one of many common rheumatoid arthritis experiences. The Centers for Disease Control and Prevention (CDC) considers an adult to have a fever when their temperature is at least 100. 4 degrees F (37.8 degrees C), with symptoms of feverishness or chills.

Fever can occur as a result of your body’s autoimmune response. Once you start treating your RA, systemic symptoms like fever should improve, notes CreakyJoints, but some people may still develop low-grade fevers on occasion, depending on their disease activity.

How Rheumatoid Arthritis Impacts Organs

In addition to heart problems, RA can increase your risk of damage to other organs, such as the lungs and kidneys.

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 2020 found that the prevalence of subclinical (symptomless) ILD was 18 percent in people who had RA for a dozen years. Other research has detected ILD in up to 60 percent of patients with RA, with 10 percent of cases being clinically significant. People with RA are nine times more likely to develop ILD than the general population, according to a review published in May 2022 in Frontiers in Medicine.

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 (which includes emphysema and 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.

Pleural effusion is another condition with increased risk. Here, the pleura — the tissue surrounding the lungs — becomes inflamed, which can lead to fluid buildup between the lung and the chest wall, according to the Arthritis Foundation.

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 Kidney Function

People with RA have a greater risk of developing chronic kidney disease, though as RA treatment has improved — including the use of biologic medications and a decrease in chronic NSAID use — kidney problems have been reduced, according to an article published in Rheumatic Diseases Clinics of North America in November 2018.

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.

RELATED: Protect Your Kidneys When You Have RA

Mental Health: Rheumatoid Arthritis and Depression

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 can 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 treatment for RA’s inflammation quells the inflammation associated with depression. The opposite may also be true: Treatment for depression (with talk therapy or medication, for example) may lessen the pain of the disease. As the Arthritis Foundation notes, while pain can incite depression, depression can also worsen pain. According to research presented at the 2021 annual congress of the European Alliance of Associations for Rheumatology (EULAR), catastrophizing about pain makes it worse, and it can actually impede RA remission.

RELATED: The Link Between RA, Depression, and Anxiety

Rheumatoid Arthritis Can Threaten 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.

According to a study in the August 2021 issue of Cureus, there are several reasons for this association: chronic joint inflammation, genetics, the role of estrogen, and the fact that certain RA medications, such as corticosteroids, can speed bone loss. Bone loss is most prevalent in areas that immediately surround joints affected by rheumatoid arthritis, notes the National Institutes of Health (NIH). Fractures most commonly occur at the spine, wrist, and hip, per the American College of Rheumatology (ACR), which notes that spine and hip fractures may lead to chronic pain, disability, and even death.

The best way to protect bones when you have rheumatoid arthritis? 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.

RELATED: What to Eat and What to Avoid for Osteoporosis Prevention

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Effects of rheumatoid arthritis on the body

RA is an autoimmune disease. Doctors also classify it as a systemic disease because it can have effects throughout the body.

Image credit: Stephen Kelly, 2018

The joints

RA can affect almost any joint in the body, and it commonly develops in the fingers, hands, and feet. It usually affects the same joint on both sides, for example, both knees. RA does not affect the sacroiliac joints, which join the spine to the pelvis. In the spine, it only affects two joints in the neck.

The condition primarily targets the lining of the joints, called the synovium. In RA, the synovium becomes inflamed, swollen, and thick, due to cell proliferation. This it can lead to stiffness, pain, and a loss of mobility. Joint pain and stiffness in the morning can be an early sign of RA.

The skeleton

The joints contain cartilage, which prevents the bones in the joint from rubbing together. Over time, inflammation from RA can cause the cartilage to break down.

If the bones rub together, it can permanently damage the joint. This is a significant cause of pain and stiffness in people with advanced RA.

RA can also cause the bones to lose density, leading to osteoporosis, which involves the bones becoming thinner and more brittle. Research from 2020 describes osteoporosis as a common complication of RA and suggests that it may happen because similar immune and inflammatory features play a role in both conditions. A loss of bone increases the risk of breaks and fractures.

People who use corticosteroids to manage RA have a higher risk of developing osteoporosis, and so experts recommend using the lowest possible dosage.

The skin

Up to 20% of people with RA develop rheumatoid nodules near the joints and pressure points. These are small, firm bumps made of inflammatory tissue.

Rheumatoid nodules develop under the skin, over bony areas. While they are often painless and generally not a cause for concern, they can cause discomfort if a person places pressure on them, such as when kneeling. In some cases, infection and ulcers can occur. The most common places for nodules are the fingers and elbows, which people often rest on the arms of a chair.

RA can also cause inflammation in the skin, sometimes leading to:

• red patches
• swelling
• infection
• ulcers, in some cases

Ulceration in RA is usually a sign of vasculitis, which involves inflammation of the blood vessels. If ulcers develop, this could indicate that the person has more active disease affecting their whole system.

RA can also cause:

• thin, wrinkled skin that bruises easily
• dry skin
• discoloration of the palms of the hands
• brittleness, splitting, or thickening of the nails
• in rare cases, papules, nodules, plaques, lesions, and ulcers

Wounds may also take longer to heal in someone with RA. Many factors related to the disease, including vasculitis, can have this effect.

In addition, some RA medications can cause skin rashes.

The mouth

People with RA may experience xerostomia, or dry mouth.

Having RA increases the risk of developing Sjögren’s disease, which causes dryness in the eyes and mouth, among other symptoms. Like RA, Sjögren’s disease is an inflammatory autoimmune disorder.

RA can also cause saliva ducts to narrow or close, leading to an uncomfortable feeling of dryness and difficulty eating and swallowing. Chronic dry mouth can contribute to gingivitis and tooth decay.

The eyes

RA can also cause inflammation in the eyes, as well as dry eye syndrome, which can lead to ongoing irritation and eventually damage the cornea.

The effects of RA on the eyes can include:

• dry eyes, a feature of Sjögren’s
• scleritis, or inflammation of the whites of the eyes
• uveitis, or inflammation of the inner eye
• retinal vascular occlusion, or blocked blood vessels in the eye
• glaucoma, which damages the optic nerve
• cataracts, which results from inflammation in the optic lens

The lungs

In around 80% of people with RA, the disease affects the lungs. This may cause no symptoms, but prolonged inflammation in the lungs can lead to pulmonary fibrosis, which can cause scarring and breathing difficulties.

Rheumatoid nodules can also form in the lungs, though these are not usually a significant cause for concern.

Some RA medications can make the immune system less effective. This can make people more vulnerable to respiratory infections, including pneumonia and tuberculosis.

The heart

Inflammation from RA can damage the heart and blood vessels. In some cases, the consequences are life threatening.

RA can cause the following complications:

• Anemia: Inflammation can lead to low level of red blood cells, resulting in symptoms such as headaches and fatigue.
• Atherosclerosis:Chronic inflammation can damage the walls of the blood vessels. This can cause the body to absorb more cholesterol, which can cause plaque to build up inside the arteries.
• Heart attack or stroke:These can result if plaque builds up and blocks an artery or another blood vessel.
• Pericarditis: RA can cause inflammation in the lining of the heart, the pericardium, leading to chest pain.

The nerves

RA causes inflammation and swelling, and it can lead to peripheral neuropathy — nerve pain throughout the body. Symptoms include pain, numbness, and burning and tingling sensations. These may develop in the hands and feet.

According to some research, peripheral neuropathy may affect almost 40% of people with RA and is more common among older people and those with more severe RA.

When RA develops in the wrist, it can lead to carpal tunnel syndrome. This occurs when inflamed tissue in the wrist squeezes a nerve that extends from the forearm.

The feet

If RA affects the feet, it can limit the person’s mobility. Because the feet bear the weight of the body, the pain can become severe.

RA often develops in the joints of the toes and, less commonly, the ankles. The condition can also lead to:

• inflamed bursae, which are painful, fluid-filled sacs that appear on the balls of the feet
• nodules on the pad of the heel, the Achilles tendon, and other bony areas, at pressure points
• corns and calluses, patches of hard, thick skin that develop as the shape of the foot changes
• ulcers, if the person does not receive treatment
• nerve compression, when RA damages a joint
• circulatory problems, if inflammation in the blood vessels and joint damage block the flow of blood to the feet

If RA causes circulatory problems, their feet or toes may become numb easily or develop a bluish tinge.

The mind and brain

Many people with RA may experience psychological effects, such as:

• depression
• problems with thinking and reasoning, including “brain fog“
• behavioral changes

These issues may occur:

• as side effects of RA medication
• in response to chronic pain
• as a result of blocked arteries in the brain
• due to a lack of exercise
• as a result of inflammation, which may be low-level

The Centers for Disease Control and Prevention (CDC) acknowledge that addressing mental health factors in people with arthritis might enhance the effects of treatment.

The kidneys and liver

Prescription medications for RA can cause complications, including liver and kidney damage. This can result from the long-term use of pain relief or anti-inflammatory medications.

RA is a progressive disease that usually worsens gradually, though medication can help slow its progress.

Over time, symptoms may become more severe or start to affect other joints or parts of the body if the treatment is not effective enough. For people with more advanced cases, surgery or joint replacements can help.

RA can be unpredictable. In the long term, people with RA may notice:

• changes in the severity and frequency of symptoms
• periods in which symptoms flare up, which can become more or less frequent
• periods of remission that vary in length

When RA progresses, symptoms occur more frequently, and pain often grows worse. Below are common indications that RA is progressing:

• pain and swelling increase
• pain and swelling occur more regularly
• other symptoms arise more frequently and last longer
• symptoms appear in new areas
• blood tests show higher levels of inflammatory markers and other biomarkers of RA

Anyone who notices new symptoms or symptoms that worsen or appear more frequently should contact a doctor.

People with RA often benefit from a tailored treatment plan. Guidelines published by the American College of Rheumatology and the European League Against Rheumatism recommend that doctors work with each individual to develop a plan that suits their specific symptoms. This may involve treatment from specialists in different areas.

What is the outlook for RA, and does it affect life expectancy?

RA is an inflammatory condition that causes pain and swelling in the joints and can also affect other areas, including the skin, eyes, brain, and cardiovascular system. It can increase the risk of other health problems, such as a heart attack or stroke.

Symptoms tend to fluctuate, worsening and improving periodically. Treatments can help manage the symptoms, slow the progression of the disease, and reduce the risk of permanent damage.

Rheumatoid arthritis | Clinical Rheumatology Hospital №25

Rheumatoid arthritis | Clinical Rheumatology Hospital №25

Rheumatoid arthritis is a chronic inflammatory disease.

Causes of rheumatoid arthritis. The impetus for the development of this disease may be one of the following factors or a combination of them:

• genetic predisposition – the risk of getting rheumatoid arthritis is increased by about 4 times in blood relatives of patients with rheumatoid arthritis. It is not the disease itself that is inherited, but the impaired response of the immune system to the action of infectious and other agents, during which arthritis develops.
• infectious agents – several infectious agents have been identified that can trigger the development of rheumatoid arthritis (rubella, herpes, Epstein-Barr viruses, retroviruses, cytomegalovirus, mycoplasma, etc.). However, none can be the only cause of rheumatoid arthritis. They are only the trigger mechanism of the pathological process.
• psycho-emotional stress and excessive physical activity – childbirth or abortion, trouble in the family or social sphere, the impact on the body of chemical, radiation, toxic factors – also provoke the development of rheumatoid arthritis.

How does rheumatoid arthritis manifest itself? How to recognize rheumatoid arthritis? What are the symptoms of rheumatoid arthritis?

The main clinical manifestations of rheumatoid arthritis include:

• morning stiffness – a feeling of stiffness in the affected joints, requiring their “development” especially in the morning. With multiple lesions of the joints, this can lead during the period of exacerbation to complete immobility of the patient, usually increasing from the middle of the night and reaching its peak by the patient’s awakening in the morning. Often the severity of morning stiffness corresponds to the level of activity of the inflammatory process. But in a small number of patients it may be mild.
• pain and deformity of the joints, swelling and limited range of motion in the affected joints – are intermittent and depend on the severity of inflammation and are especially disturbing during exercise. However, with the development of pronounced destruction of the joints and the formation of contractures, restrictions on movements are already permanent. A feature of rheumatoid arthritis is a symmetrical lesion of the joints (for example, small joints of both hands).
• temperature, weight loss, general weakness – may appear at the beginning of the disease even before the development of typical changes in the joints and increase with an exacerbation of the disease.

DEVELOPMENT OF RHEUMATOID ARTHRITIS is based on autoimmune inflammation, as a result of which the immune system, due to a violation of its functions, instead of “attacking” the enemies of the body (microbes, viruses, tumor cells), begins to “attack” its own cells. An immune response is formed, leading to damage to one’s own tissues or organs. The cells of the immune system produce specific proteins – various antibodies against the body’s own cells – autoantibodies. Some of them are called rheumatoid factor (RF) and are regularly evaluated in your blood when taking tests, not only during the diagnosis, but also during treatment. The level of rheumatoid factor characterizes the activity of the disease and helps to evaluate the effectiveness of therapy. In rheumatoid arthritis, the tissues of the joints are primarily affected. For many people, the initial symptoms of arthritis are very vague and include weakness, muscle pain, and a low temperature.

CHANGES IN THE JOINTS in rheumatoid arthritis are the result of several processes:

1. A chronic inflammatory process leads to a gradually increasing destruction of cartilage and bones. The main destruction of joint structures in rheumatoid arthritis is caused by pannus, an aggressive tissue that begins to grow under the influence of factors produced by the immune system in the joint cavity. The mechanism of destruction is associated both with the mechanical pressure of the growing pannus, and with the formation of a large number of various aggressive enzymes that “corrode” the tissues of the joint. And in the adjacent bone tissue, these same processes cause rarefaction – “periarticular osteoporosis”.

2. Under the influence of a large number of different substances that are produced by the cells of the immune system and are formed as a result of the destruction of joint tissues, nearby soft tissues begin to change. There is a gradual atrophy of the muscles, contractures are formed.

All this leads to those external deformations of the joints, which are a characteristic feature of rheumatoid arthritis. With no other disease, the joints do not change so much. This is especially significant in the small joints of the hands and feet.

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