About 1.3 million Americans live with the chronic pain and discomfort of rheumatoid arthritis (RA), an autoimmune disorder in which the immune system attacks healthy cells in the joints, causing inflammation. This not only leads to excruciating stiffness, swelling, and tenderness in the joints that can make you dread doing everyday tasks, it can also impact other parts of your body.
“In more severe cases, the inflammation can target other organ systems such as the heart and lungs,” explains Elizabeth Thomas, DO, a rheumatology specialist with Arthritis, Rheumatic & Back Disease Associates in New Jersey. This could lead to conditions from dry mouth to heart disease.
Below, Dr. Thomas explains the most common complications and gives advice on how to deal with them.
Note: Always work with your healthcare provider to develop the best treatment plan for you and your health condition. Your doctor can help you control the inflammation caused by RA through lifestyle changes and/or medication.
1. Joint damage
Leaving joint pain, swelling, and inflammation untreated can result in joint damage, and may eventually erode the bone, Dr. Thomas explains. As the disease progresses, the swelling and inflammation can also weaken the tissues and ligaments that hold the joints in place, causing deformities.
How to protect yourself
Make sure your rheumatologist takes baseline x-rays of your hands and feet to see if there’s any damage or bone erosions, says Dr. Thomas. You can also ask if your doctor feels a musculoskeletal ultrasound—which looks for inflammation and early damage to the joints—might be beneficial.
Based on the results of the imaging, your MD may prescribe disease-modifying antirheumatic drugs (DMARDs), which target specific aspects of the immune system to control inflammation. These medications will help protect your joints and stop the development of bone erosions (but cannot fully repair existing ones).
Additionally, although you may think it’s best to be less active, if you’re in pain or have stiffness, think again. Becoming idle increases the chances of muscle atrophy and decreased joint movement, and staying active can help maintain or build muscle, increase strength, and improve function. Work with your doctor, physical therapist, or an experienced personal trainer who works with RA patients to identify activities that will not cause pain.
2. Osteoporosis
“Oftentimes, patients with RA require courses of steroids to help control inflammation,” says Dr. Thomas. Long-term use of steroids can accelerate bone density loss, resulting in osteoporosis or low bone density. This happens because steroids decrease the number of osteoblasts, the cells that form bones. RA steroids are actually the most common cause of secondary osteoporosis, which is a type of osteoporosis caused by health conditions or medications.
How to protect yourself
Follow all of the best practices for strong bones, including getting 1,200 mg of calcium and 2,000 IU of vitamin D in your diet each day.
Good food sources of calcium include dairy products, leafy greens, and sesame seeds or tahini. Fatty fish, egg yolks, and fortified milk are good sources of vitamin D. If you’re concerned that you aren’t hitting the nutritional mark, your doctor can do blood work to check your levels of these nutrients. If it turns out you’re coming up short, your MD might recommend a supplement.
The other thing that’s key for strong bones is regularly doing weight-bearing exercise such as lifting weights or using resistance bands. While walking does support cardiovascular health, it doesn’t help with bone density. Consider jogging or alternating walking and jogging to get maximum bone benefits.
3. Lung disease
Although Dr. Thomas says it’s a rare complication, some medications used to treat RA and the disease itself can cause lung problems. In fact, 10 to 20 percent of RA deaths are due to pulmonary problems. These can include:
- Interstitial lung disease: This is a group of lung disorders that cause inflammation and scarring of the lung tissue. It’s the most common lung problem associated with RA.
- Pleural disease: The tissue that lines the chest cavity and the outside of the lungs is called the pleura. RA can cause the fluid between these two layers to build up, according to the Mayo Clinic. When this occurs, it can cause shortness of breath, fever, and painful breathing.
- Small airway obstruction: This is a result of chronic inflammation, and can cause shortness of breath, chronic cough, fatigue, weakness, and mucus build-up in the lungs, according to the Mayo Clinic.
- Nodules: When found in the lungs, these small growths of tissue are usually asymptomatic. However, they can rupture, causing the lung to collapse.
How to protect yourself
Your doctor will monitor your symptoms. If you ever experience shortness of breath or a cough, which may be a sign of some of these conditions, see your healthcare provider. They may send you for chest imaging or to a pulmonologist for further evaluation, Dr. Thomas says.
Also, don’t smoke. If you currently use cigarettes, talk to your doctor about finding a cessation program.
4. Heart complications
“Rheumatoid arthritis is an independent risk factor for cardiovascular disease,” says Dr. Thomas. That means that RA in and of itself is linked to cardiovascular disease; it’s not that other complications of RA are the cause of increased risk of heart disease. In fact, patients with RA have a 50 to 70 percent greater risk of heart disease compared with the rest of the population. This is likely due to the inflammation, says Dr. Thomas. In addition, research suggests that HDL (the “good” cholesterol) may be less efficient at removing “bad” cholesterol buildup from the wall of the arteries in people who have RA. It’s unclear why this happens.
How to protect yourself
Dr. Thomas recommends working with your doctor to control the inflammation caused by RA with medication and lifestyle changes.
Then, talk to your primary care physician or a cardiologist about managing other risk factors, including hypertension (high blood pressure), diabetes, and high cholesterol. In addition to medications, they might recommend staying active and following a healthy, balanced diet. The American Heart Association (AHA) recommends 150 minutes of moderate-intensity aerobic activity (e.g., brisk walking) or 75 minutes of vigorous aerobic activity (e.g., jogging or running), plus two days of strength training each week. However, with RA, it’s best to do as much as your condition allows, according to the Department of Health and Human Services (HHS). Work with your doctor, who can also help advise on appropriate types and amounts of exercise.
The AHA also recommends increasing your consumption of whole foods (such as vegetables, fruit, lean proteins, whole grains, beans, and non-tropical oils) and limiting processed foods such as chips, chicken strips, frozen meals, and granola—basically most things that come in a package and have added sugars, sodium, and unhealthy fats.
5. Sjögren’s syndrome
“A lot of times, people with rheumatoid arthritis have dry eyes and mouth,” Dr. Thomas says. This is called Sjögren’s syndrome. This autoimmune disease often occurs when someone has other autoimmune diseases, including RA, although it’s unclear exactly why this is. It may be the combination of a compromised immune system and the inflammation from RA that affects the glands that make tears and saliva.
People who have more severe arthritis and who have had RA for longer are more likely to have Sjögren’s syndrome.
How to protect yourself
There is no way to prevent Sjögren’s, but you can make it more comfortable to live with. For dry eye relief, your doctor may recommend either OTC or prescription eye drops. For dry mouth, Dr. Thomas recommends staying hydrated and eating sugar-free candies or gum. These can help stimulate salivation without increasing the risk of cavities. And in severe cases, your doctors can prescribe medication to help alleviate symptoms.
“Dry mouth may increase the risk for cavities, so we recommend regular, routine dental care at least twice yearly,” says Dr. Thomas. “Your dentist may also provide you with a prescription toothpaste to help prevent cavities.”
Thanks to Christopher Gaffney, PhD, director, physician services of Arthritis, Rheumatic & Back Disease Associates for his assistance with this article.
