You know that arthritis affects your joints.
In addition to painful, swollen joints your arthritis can sometimes affect other parts of your body such as your skin, eyes and lungs, to name a few.
Rheumatoid arthritis (RA) is a systemic disease, meaning it can affect other parts of the body. Also some of the medications used to treat RA can cause side effects. Some of these issues, such as bone thinning or changes in kidney function don’t cause immediate symptoms so your doctor may monitor you through lab tests or check-ups. For other issues, such as skin rashes or dry mouth it’s important that they get looked early to prevent complications. It is important to report any symptoms you feel to your doctor, so that they can investigate and adjust your treatment plan accordingly.
Some of these issues – such as bone thinning or changes in kidney function – cause no immediate symptoms so your doctor may monitor you through lab tests or check-ups. For other problems – such as skin rashes or dry mouth – it’s important to report any symptoms your feel to your doctor, so that they can investigate and adjust your treatment plan accordingly.
About half of people with RA develop rheumatoid nodules – lumps of tissue that form under the skin, often over bony areas exposed to pressure, such as fingers or elbows. Unless the nodule is located in a sensitive spot, such as where you hold a pen, treatment may not be necessary. Nodules sometimes disappear on their own or with treatment with disease-modifying antirheumatic drugs (DMARDs).
When RA-related inflammation of the blood vessels (called vasculitis) affects the skin, a rash of small red dots can appear. In more severe cases, vasculitis can cause skin ulcers often on the legs or under the nails. This may be a sign that your RA is not ideally controlled and these symptoms generally improve by improving the control of your RA.
Different medicines can cause different side effects. Your doctor will usually explain the more common side effects to watch out for and things you can do to minimise these effects. For example, corticosteroids, prescribed to reduce inflammation, can cause thinning of the skin and increase your susceptibility to bruising. Non-steroidal anti-inflammatory drugs (NSAIDs), which treat pain and inflammation, and methotrexate, a widely prescribed DMARD, can cause increase your sensitivity to sun exposure. So you may need to take extra care to avoid getting sunburn. People taking biologics, a sub-category of DMARDs designed to stop inflammation at the cellular level, may develop a rash at the injection site.
Chronic inflammation from RA leads to loss of bone density, not only around the joints, but throughout the body, leading to thin, brittle bones. Exercise, a high-calcium diet and vitamin D can all help bones, but in some cases your doctor may need to prescribe additional medicines to prevent your bones from becoming "brittle".
Corticosteroids can also cause bone thinning.
Some people with RA develop inflammation of the whites of the eyes (scleritis) that can lead to scarring. Symptoms include pain, redness, blurred vision and light sensitivity. Scleritis is usually treatable with medications prescribed by your doctor, but in rare cases, the eye may be permanently damaged. RA can also cause uveitis, an inflammation of the area between the retina and the white of the eye, which, if not treated, could cause blindness.
The inflammatory process that affects the joints can also damage the tear-producing glands, a condition known as Sjögren’s syndrome. The result is eyes that feel dry and gritty. Artificial tears, which are available over the counter, as well as medications your doctor prescribes, can keep eyes more comfortable and help prevent damage related to dryness.
Corticosteroids may cause glaucoma and cataracts. Hydroxychloroquine, in rare cases, causes pigment changes in the retina that can lead to vision loss. As a rule, people with RA should get eye check-ups at least once a year.
Inflammation can damage the moisture-producing glands of the mouth as well as the eyes, resulting in a dry mouth. Over-the-counter artificial saliva products and self-treatment often helps. If not, your doctor may prescribe a medication to increase the production of saliva. Good dental hygiene is a must, as bacteria tend to flourish in a dry mouth, leading to tooth decay and gum disease.
Methotrexate can cause mouth sores or oral ulcers. For treatment, try a topical pain reliever or ask your doctor or dentist for a medicated mouthwash.
Up to 80 percent of people with RA have some degree of lung involvement, which is usually not severe enough to cause symptoms. However, in some cases severe, prolonged inflammation of the lung tissue can lead to a form of lung disease called pulmonary fibrosis that interferes with breathing and can be difficult to treat.
Rheumatoid nodules might form in the lungs, but these are usually harmless.
Methotrexate can cause a complication known as methotrexate lung or methotrexate pneumonia, which generally goes away when the methotrexate is stopped. Less common drugs, including injectable gold and penicillamine, can cause similar pneumonias. The condition goes away when treatment ceases; patients can usually resume the drug in a few weeks.
By suppressing your immune system, corticosteroids, DMARDs and biologics may increase your risk of tuberculosis (TB), a bacterial infection of the lungs. Your doctor will usually test for TB before initiating treatment and then monitor for TB periodically.
Chronic inflammation can damage cells that line the blood vessels, causing the vessels to absorb more cholesterol and form plaques. Just like someone with high cholesterol due to a poor diet, this atherosclerosis increases your risk of cardiovascular disease and needs to be monitored.
When plaques from damaged blood vessels break lose, they can block a vessel, leading to heart attack or stroke. As people with RA have a higher risk of atherosclerosis, the risk of a heart attack also appears to be increased. There are steps you can take to help improve your cardiovascular health and this is something your doctors will help you with.
Pericarditis is an inflammation of the heart lining, the pericardium. This can occur in some people with RA and may felt as chest pain. Treatments used to control arthritis often also controls pericarditis.
While many RA medications, including methotrexate, other DMARDS and biologics may reduce cardiovascular risk in people with RA, other medications – chiefly NSAIDs – may increase the risk of cardiovascular events including heart attack. Your doctor will assess your risks when developing your RA management plan.
Although RA doesn’t directly harm the liver, some medications taken for RA can. For example, long-term use of the pain reliever paracetamol can cause liver problems. Liver diseases may also occur with long-term methotrexate use. Your rheumatologist will monitor your liver function, via blood tests, to help prevent problems from occurring.
As with the liver, medicines taken for arthritis can sometimes lead to kidney problems. The most common medications include cyclosporine, methotrexate and NSAIDs. Your doctor will monitor your kidney function to help prevent problems from occurring.
Unchecked inflammation can lead to a reduction in red blood cells, causing symptoms such as headache and fatigue. Anaemia can be managed by taking medicines to control your RA and reduce inflammation and some people will need to take iron supplements. Your doctor will monitor this with your routine blood tests.
Inflammation might lead to elevated blood platelet levels, and blood clots.
Sometimes RA requires aggressive treatment with corticosteroids. In these situations the high doses of corticosteroids may cause thrombocytopenia, an abnormally low number of blood platelets. Thrombocytopenia reduces your body’s ability to stop bleeds. If affected, you may bruise easily or notice that you have prolonged bleeding following a cut.
Although RA does not directly affect the nerves, inflammation of tissues may cause compression of the nerves resulting in numbness or tingling. One relatively common problem is carpal tunnel syndrome, a condition in which the nerve that runs from the forearm to the hand is compressed by inflamed tissue in the wrist area, resulting in tingling, numbness and decreased grip strength.
Remember, if you experience anything unusual or troublesome contact your rheumatologist or GP and they will be able to help.