We all are quite aware that arthritis causes unremitting pain and damage to the joints. Painful, swollen and stiff knees, fingers or elbow are impossible to ignore. But did you know the fact that other parts of your body such as skin, heart, lungs, kidney and eyes to name a few – may also be affected?
Rheumatoid arthritis is an autoimmune inflammatory disease that damages the joints and surrounding connective tissues, it occurs in a systemic form which means it affects other parts of the body too.
Following is the list of the body part and the ways rheumatoid arthritis and its drug affect them.
Health conditions such as bone thinning or changes in kidney function cause no immediate symptoms therefore your doctor may monitor you through various tests or regular checkups to confirm. For other problems such as skin rashes or dry mouth, it’s necessary to report the symptoms to your doctor immediately, to determine the underlying cause and plan an effective treatment approach accordingly.
Bone thinning– Chronic inflammation leads to loss of bone density, not only around the joints and whole body, leading to thin and brittle bones. Regular exercise with a boost of high-calcium diet and vitamin D can help to maintain bone health, but in some cases, your doctor may need to prescribe medications to stimulate bone growth or prevent bone loss.
Use of steroids can cause bone thinning.
Rheumatoid Nodules- About half of the people with rheumatoid arthritis develop lumps under the skin, often over bony areas that are exposed to pressure such as elbows or finger. Unless the rheumatoid nodule is located in a sensitive place that limits mobility, treatment may not be necessary. These nodules sometimes disappear on their own or with treatment or medications such as disease-modifying antirheumatic drugs (DMARDs).
Rashes- When vasculitis (inflammation of the blood vessels) affects the skin, an outbreak of small red dots is noticed. In more severe cases, vasculitis can also cause skin ulcers on the legs or under the nails. Controlling rashes or ulcers requires controlling the underlying inflammation.
Steroids are prescribed to reduce inflammation but can cause thinning of the skin and increase susceptibility to bruising.
Non-steroidal anti-inflammatory drugs (NSAIDs), which treat pain and inflammation.
DMARD can cause sun sensitivity.
Biologic DMARDs are designed to stop inflammation at the cellular level which often develops a rash at the injection site.
Inflammation and scarring- Some people with rheumatoid arthritis develop scleritis (inflammation of the eyes) that leads to scarring. Symptoms may include pain, redness, blurred vision and light sensitivity. Scleritis is usually treated with medications, but in a rare case, the eyes may be permanently damaged. Rheumatoid arthritis can also cause uveitis, an inflammation of the retina, which, if not treated, could cause permanent blindness.
Dryness- The inflammation of joints can also damage the tear-producing glands, (called as Sjögren’s syndrome) resulting in dry and gritty eyes. Artificial tears or eye drops, which are available over the counter, as well as medications, can prevent the damage related to dryness.
Steroids may cause glaucoma and cataracts.
Hydroxychloroquine which is used in rare cases causes pigment changes in the retina that can lead to vision loss.
Note: As a rule, people with rheumatoid arthritis should get eye check ups at least once a year.
Dryness- Inflammation can damage the moisture-producing glands of the mouth, causing dry mouth. Over-the-counter artificial saliva drugs and self-treatment often help to treat dry mouth. If not, your doctor may prescribe certain medications to increase the production of saliva.
Note: Poor dental hygiene can enable bacteria to flourish and cause tooth decay and gum disease. Therefore people who have rheumatoid arthritis are advised to maintain good oral health.
Methotrexate can cause mouth sores or oral ulcers. Try a topical pain reliever or mouthwash as prescribed by your dentist.
Inflammation and scarring- Up to 80% of people with rheumatoid arthritis face some degree of lung problem, which may not be severe enough to cause symptoms. However, acute, prolonged inflammation of the lung tissue can cause a lung disease (called as pulmonary fibrosis) that interferes with breathing and can be challenging to treat.
Rheumatoid nodules- Nodules might develop in the lungs, but are usually harmless.
Use of methotrexate can lead to a complication known as methotrexate lung or methotrexate pneumonia, which goes away when the use of methotrexate is stopped.
In some cases where less common drugs, such as injectable gold and penicillamine, can cause pneumonia. The condition goes away when treatment ceases; patients can usually resume the medication in a few weeks.
By suppressing your immune system, steroids, and DMARDs may increase your risk of tuberculosis (TB). Your doctor should test for TB before initiating treatment and would continue it periodically too.
Heart and Blood Vessels
Heart attack and stroke- When plaques from damaged blood vessels break, they tend to block the vessel, leading to heart attack or a stroke. In fact, a study states that the risk of heart attack for people with rheumatoid arthritis was 60 percent higher just one year after being diagnosed with rheumatoid arthritis.
Atherosclerosis- Chronic inflammation can damage endothelial cells, lining the blood vessels, causing the vessels to absorb more cholesterol and form plaques.
Pericarditis- Inflammation of the heart lining(pericardium), may manifest as chest pain. Treatment to control rheumatoid arthritis also controls pericarditis as well.
While medications such as methotrexate, other DMARDs and biologics may reduce cardiovascular risk in people with rheumatoid arthritis, other medications, mainly NSAIDs, may increase the risk of cardiovascular diseases including heart attack. Your doctor will evaluate your risk while prescribing a treatment plan for rheumatoid arthritis.
Blood clots- Inflammation might lead to elevated blood levels and forms blood clots.
Anemia- Unchecked inflammation can lead to a reduction in RBC count characterized by consistent headache and fatigue. Treatment involves the use of drugs to control inflammation along with iron supplements.
Felty syndrome- In rare cases, people with longstanding rheumatoid arthritis can develop Felty syndrome which is identified by an enlarged spleen and low white blood cell count. Felty syndrome increases the risk of infection and lymphoma (lymph glands cancer). The doctors generally prescribe immunosuppressant drugs to treat this condition.
Aggressively treating inflammation with steroids may cause thrombocytopenia, a condition with an abnormally low blood platelet count.
Pinched or compressed nerves- Although rheumatoid arthritis does not directly affect the nerves, inflammation of tissues may cause compression of the nerves causing numbness or tingling.
Carpal tunnel syndrome- A medical condition in which the nerve that runs from the forearm to the hand is compressed by inflamed tissue in the wrist area, causing tingling, numbness and decreased grip strength.
Rheumatoid arthritis often decrease the quality of life and also affects other parts of our body apart of joints. Therefore, it is essential to consult a rheumatologist periodically to check if there are any possibilities of any other health problem due to rheumatoid arthritis.
A rheumatology specialist is a trained doctor who diagnoses, treats and manages problems associated with joints, muscle, soft tissue, vasculitis,osteoarthritis and heritable connective tissue disorder.They closely work in collaboration with other specialists such as orthopaedics, cardiologist, pulmonologist, neurologist to treat and manage rheumatoid arthritis and other health conditions related to rheumatology that includes rheumatoid arthritis, dryness of mouth and eyes, atherosclerosis, anemia and many more .
Department of Rheumatology
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