The course of rheumatoid arthritis differs from person to person. For some patients, they disease becomes less aggressive over time and symptoms may improve. Other people develop a more severe form of the disease, which can lead to serious complications that affect not only the joints but other areas of the body including organs. Fortunately, for many patients newer treatments are helping slow the progression of the disease and preventing severe disability.
Complications of rheumatoid arthritis, many of which are the result of chronic inflammation, can include:
Joint Deterioration and Pain
Affected joints can become deformed, and for some patients the performance of even ordinary tasks can become very difficult or impossible. In addition to pain, patients may also experience muscle weakness.
This condition affects the nerves, most often those in the hands and feet. It can result in tingling, numbness, or burning.
People with RA may develop anemia, which involves a decrease in the number of red blood cells.
Scleritis and episcleritis are inflammations of the blood vessels in the eye that can result in corneal damage. Symptoms include redness of the eye and a gritty sensation.
Patients with RA have a higher risk for infections, particularly if they are treated with immune-suppressing drugs (such as corticosteroids, anti-tumor necrosis factors, and disease modifying drugs).
Skin problems are common, particularly on the fingers and under the nails. Some patients develop severe skin complications that include rash, ulcers, blisters (which may bleed in some cases), lumps or nodules under the skin, and other problems. In general, severe skin involvement reflects a more serious form of RA.
Osteoporosis, loss of bone density, is more common than average in postmenopausal women with RA. The hip is particularly affected. The risk for osteoporosis also appears to be higher than average in men with RA who are over 60 years old.
Patients with RA are susceptible to chronic lung diseases, including interstitial fibrosis, pulmonary hypertension, and other problems. Both rheumatoid arthritis itself and some of the drugs used to treat it may cause this damage.
Vasculitis involves inflammation in small blood vessels and can affect many organs in the body. Manifestations of vasculitis include mouth ulcers, nerve disorders, rapid worsening of the lungs, inflammation of coronary arteries, and inflammation of the arteries supplying blood to the intestines.
Patients with RA have increased risk for death from coronary artery disease. Research suggests that the chronic inflammation associated with RA may be a factor.
Lymphoma and Other Cancers
Patients with RA are more likely than healthy patients to develop non-Hodgkin's lymphoma. RA's chronic inflammatory process may play a role in the development of this cancer. Anti-TNF drugs used for RA treatment may also increase the risk for lymphoma (particularly in children and adolescents) as well as leukemia and other malignancies.
People with RA have a higher risk for developing periodontal disease, which damages the gum and bone around the teeth.
Kidney and Liver Problems
Although rheumatoid arthritis only rarely involves the kidney, some of the drugs used to treat it can damage kidneys and the liver.
Women with RA have an increased risk for premature delivery. They are also more likely than healthy women to develop high blood pressure during the last trimester of pregnancy. For many women with RA, the disease goes into remission during pregnancy but after birth the condition recurs and symptoms can increase in severity.
Review Date: 02/16/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.