10 Health Risks Linked to Rheumatoid Arthritis
More than RA
If you have rheumatoid arthritis (RA), be on the lookout for other health problems associated with the autoimmune disorder.
They may be caused by RA-related inflammation or RA treatments, or they may occur at higher rates for unknown reasons.
Regardless of the cause, most related conditions can be prevented or treated. Although it’s challenging to cope with the pain and fatigue of RA—much less other health problems—it makes sense to keep an eye out for the signs and symptoms of these conditions.
In addition, people with RA often cut back on activity due to pain, which can accelerate loss of bone and muscle mass, says Guy Fiocco, MD, assistant professor of internal medicine at Texas A&M Health Science Center College of Medicine, in Temple.
Have regular bone-density scans and talk to your doctor about bone-strengthening medications and exercise. Also, get enough calcium and vitamin D, Dr. Fiocco says.
Heart disease and stroke
"Rheumatoid arthritis is considered equal to other [heart-disease] risk factors, such as diabetes, hypertension, increased lipids, smoking, and family history," Dr. Fiocco says. "It’s at least as important as the other risk factors for premature heart disease and stroke."
RA-related inflammation is thought to be the reason why, although some RA medications can contribute to the risk. People with RA should make an extra effort to eat heart-healthy food, manage other risk factors (like avoiding smoking), and monitor cholesterol and blood pressure.
Unfortunately, there’s no treatment for Sjögren’s, which can lead to vision problems and tooth decay because of the lack of saliva. Moisturizing eye drops, good dental hygiene, and drinking water can help prevent these problems.
Prescription drugs such as cevimeline (Evoxac) and pilocarpine (Salagen) can increase the production of saliva and tears. In severe cases, minor surgery can relieve dryness in the eyes.
RA patients have a two to four times higher risk than people without RA. Other blood cancers, such as leukemia and other forms of lymphoma, as well as lung cancer and melanoma, may also be a problem. Not only is the disease itself a culprit, but some drugs are too.
In fact, methotrexate (Trexall) and antitumor necrosis factor drugs such as adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) carry a warning about increased lymphoma risk. But the benefits may still outweigh the risk, given that the risk is low overall.
In addition to the joints, RA can attack the lungs and cause scarring. Over time, this can make breathing difficult. RA treatments such as methotrexate and glucocorticosteroids can increase the risk of interstitial lung disease.
People with RA may also develop inflammation in the lining of the lungs, or pleurisy, which can make breathing painful, and lung nodules, which can be mistaken for cancer.
One risk is tuberculosis (TB), although it is less common in the U.S. than in developing nations.
Still, doctors routinely perform a skin test to check for TB before starting a person on immune-suppressing drugs, Dr. Fiocco says. If the test is positive, the doctor will treat the infection first.
One small study showed that only 1 in 5 RA patients talk to their doctor about depression. If you have symptoms of depression, get help.
"With the newer [RA] medications, a lot more quality of life is being maintained these days," says Dr. Fiocco.
"Anemia is directly related to the activity of the disease," says Dr. Fiocco. "High levels of inflammation lead to greater degrees of anemia and these are closely correlated."
Medication can also exacerbate the problem. If the anemia is due to inflammation, getting it under control will help, Dr. Matteson says. Drugs that spur red-blood-cell production can help too. And if you’re iron deficient, consider iron supplements, but keep in mind that highly active RA can inhibit iron absorption.
It’s a serious side effect to watch for, although it doesn’t affect a lot of patients. "Probably less than 1%, but if it does occur, it’s a very serious problem," Dr. Matteson says.
"The combination of NSAIDs plus steroids makes it even worse," Dr. Fiocco says. GI bleeding can also cause or worsen anemia. If you’re taking a prescription NSAID, you should be monitored for this side effect.
If you’re taking an over-the-counter NSAID, stick to the recommended dosage and don’t take more than one NSAID, including aspirin, at a time.