What are the complications of rheumatoid arthritis (RA)?

What is rheumatoid arthritis (RA)?

Rheumatoid arthritis (RA) is an autoimmune disease affecting 0.5% to 1% of the global adult population. It can occur at any age, but typically appears between 30 and 50 years old, with a peak around age 45. Women are two to three times more likely to develop RA than men.

What are the early signs of rheumatoid arthritis?

The first signs of RA often include painful stiffness and swelling in multiple joints, particularly the wrists, hands, and fingers.

Symptoms are more intense late at night and in the morning. The stiffness tends to ease after several minutes of movement, a phenomenon known as “morning stiffness.”

Other early signs may include fatigue, tiredness, and loss of appetite. At this stage, treatment is most effective and offers the best long-term prognosis.

How does rheumatoid arthritis progress?

As the disease advances, it progresses in flare-ups, with periods of remission in between. Over time, other joints, including the elbows, shoulders, neck, feet, toes, knees, and hips, may become involved. RA typically affects joints symmetrically on both sides of the body, leading to chronic pain.

After several years, RA can cause joint deformities and tendon damage. In severe cases, orthopaedic surgery may be necessary to repair or replace joints with prostheses. RA is disabling in 20% to 25% of patients.

What are the complications of rheumatoid arthritis?

RA is associated with numerous complications, many of which result from chronic inflammation in the body. Here are the most common ones:

Cardiovascular disease

RA significantly increases the risk of cardiovascular conditions such as heart attack, angina, deep vein thrombosis, and stroke. These cardiovascular complications, driven by chronic inflammation, are the leading cause of death among people with RA.

To reduce the risk, it is crucial to quit smoking, eat a balanced diet, and engage in regular physical activity. Regular medical checkups are also important to monitor and treat other risk factors like high cholesterol, high blood pressure, diabetes, and excess weight.

Osteoporosis

RA is a risk factor for osteoporosis, a disease marked by reduced bone density and strength. Chronic inflammation, common in RA, contributes to this bone loss.

Dry eye syndrome

About 10% to 30% of people with RA experience dry eye syndrome, characterized by dryness in the eyes and mouth.

Rheumatoid nodules

Rheumatoid nodules are hard, painless lumps that usually appear after several years of RA progression. They most commonly form under the skin of the forearms, elbows, fingers, and sometimes knees. These nodules may grow or shrink slowly, disappear on their own, or respond to RA treatment.

Vasculitis (vascular inflammation)

Vasculitis, the inflammation of blood vessels, affects small arteries and veins. It is thought to result from the build-up of antibody complexes on blood vessel walls. Symptoms include red spots around the nails, skin ulcers, and circulation issues in the fingers and toes.

Lung and heart complications

Long-term RA treatments, particularly corticosteroids, may raise the risk of pneumonia or pericarditis (inflammation of the heart's outer membrane).

Other complications

• Anaemia: A common complication of RA, its severity depends on the disease's activity.
• Scleritis: Inflammation of the white outer layer of the eye, which can take time to heal.
• Kidney Complications: These may arise from amyloid deposits (protein build-up) or side effects of RA medications.
• Skin Issues: Possible signs include red palms, yellow nails, or Raynaud’s phenomenon.

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