Do you know about the possible complications of Rheumatoid Arthritis?

As you may already know, rheumatoid arthritis (RA) is both a disfiguring and debilitating disease.  Joint pain, stiffness, inflammation and damage can make it difficult to perform daily tasks.  Most RA patients find themselves worn out by daily activity and eventually some are unable to continue doing them.  We have been fortunate, however, that new therapies are available and more effective in slowing down or stopping joint damage. 

Unpredictability

The hardest part for most patients, including myself, is the unpredictable nature of RA.  In other words, we never know when the next flare up will be.  We cannot plan for them and we cannot always stop them from happening.  It is possible to control to severity and we can find that some days are better than others.  With flare-ups being so unpredictable, it is not usual to become depressed as a result of associated anxiety and stress.

Joint pain, added stress and anxiety and depression make RA patients more vulnerable to developing disease complications.  This is because the autoimmune process that causes joint inflammation can also affect the eyes, lungs, skin, heart, blood vessels and other organs of the body.  Medications also cause unwanted side effects.

Recognizing early symptoms of potential complications

To manage complications of RA, it is important to recognize symptoms early and get appropriate treatment.  Here are some potential issues you should look out for.

  • ·         Skin problems: About 20% of RA patients will develop rheumatoid nodules.  These are lumps of tissues that generally appear under the skin on elbows, forearm, heels or fingers.  They are an indication of severe disease activity.  It is also possible for them to appear on the lungs or heart.  Inflammation of blood vessels called vasculitis causes skin changes and appear as ulcers on the skin. Other types of rashes/skin changes are possible with RA as a result of disease activity or medication so it is important to alert your doctor of any skin changes you develop.
  • ·         Eye problems: RA can affect the eyes in several ways.  These include inflammation on thin membrane and covering the white of the eye, called the sclera, or inflammation of the sclera. I have gone into detail about the eye conditions associated with RA in this post
    • o   Sjogren’s syndrome: With RA, you are at a higher risk of Sjogren’s.  This is a condition in which the immune system attacks the lacrimal glands, the glands which help us to produce tears.  Eyes can feel gritty and dry and if not treated can lead to infection and scaring of the membrane that covers the eye. RA patients should have regular eye exams but if you are already showing symptoms, let your doctor now about them.
  • ·         Heart and blood vessels:  Many RA patients have a collection of fluid between the pericardium and heart itself called pericardial effusion.   However, not all RA patients have symptoms.  Episodes of pericarditis or inflation of the heart membrane usually develop during flare periods. Persistent pericarditis can interfere with the heart’s ability to work property.  For more information on heart complications with RA, please review this article.
  • ·         Disease of the blood and blood forming cells: Many RA patients experience anemia which causes symptoms such as fatigue, rapid heartbeat, shortness of breath, leg cramps, insomnia and dizziness.  Sometimes, treatment to suppress the immune system can lead to thrombocytopenia, a condition where low levels of blood platelets are present. Felty’s syndrome is also a complication of RA, but fairly uncommon.   This is a condition where the spleen is enlarged and the white blood cell is low.  Felty’s syndrome increases the risk of lymphoma cancer (cancer of the lymph nodes).
  • ·         Lung problems: The same inflammatory process affecting the lining of the heart can also affect the lining of the lungs.  For more information on the various lung complications, please refer to this article.  RA treatment can also affect the lungs.  Methotrexate, for example, can affect the lungs and cause shortness of breath, cough and fever.  Symptoms, in this case, improve after the medication is stopped.
  • ·         Infection susceptibility:  People with RA are prone to infection which is both associated with the disease and medications to treat it.  If you think you have an infection, contact your treating physician for monitoring and treatment.
  • ·         Depression:  As mentioned, living with RA pain and limitations can take a toll on your emotional health.  For more information on RA and depression, please check out this article.

How you protect yourself from RA complications? 

Most patients do not think to mention things like moods, chest pain or dry eyes to their doctor, but it is very important to let your doctor know that you are experiencing these kinds of symptoms.  Your doctor can work with you to either treat your symptoms or act more aggressively in treating rheumatoid arthritis.  Whatever the route taken, your speaking up is the first and most important step in managing and resolving problems that have the potential to turn into serious complications.  

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