Rheumatoid Arthritis Complications and Comorbidities

Patient Expert
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Rheumatoid arthritis (RA) isn’t just a bit of arthritis. It’s a serious disease that affects the joints and other systems in the body, including organs, tendons, and the vascular system.

Untreated, RA can cause serious complications. And when you have RA, you may also develop comorbidities, a word for medical conditions that occur with the main disease. We have articles on many of these complications and comorbidities in our archives, but wanted to present a more comprehensive list in one place. Follow the links to learn more about each individual condition.

Heart disease. Cardiovascular disease is one of the primary effects of untreated RA. In fact, people with RA have historically had what’s called a mortality gap: their life expectancy was as much as ten years shorter than the general population. This has changed as more and better treatment options have become available, and the mortality gap has now shrunk to being much more similar to the population average.

Kidney disease. People with RA have a one in four risk of developing kidney disease. Two factors contribute to this: the systemic inflammation of RA, and the medications we take to treat it. Ask your doctor to include a test of kidney function in your regular blood tests to monitor the situation. You may also want to reduce salt and drink plenty of fluids.

Diabetes. When you have RA, you may be at a higher risk of developing Type 2 diabetes. Risk factors contributing to this include a more sedentary lifestyle due to pain, weight gain, and taking steroids. Talk to your doctors about ways to prevent diabetes, and ask them to test your sugar on a regular basis.

Vasculitis. Rheumatoid vasculitis is rare, occurring in approximately 1 to 5 percent of people who have RA. This happens when systemic inflammation affects small- and medium-sized blood vessels. This can impede the flow of blood, as well as cause damage to your body’s tissues. Unfortunately, this condition has a substantial fatality risk.

Eye complications. RA inflammation can cause scleritis, inflammation of the sclera (the white part of the eye). Other eye complications include dry eye, Sjögren’s syndrome (see below), glaucoma, and cataracts. To protect your eye health, it’s important to schedule regular (at least annual) checkups with an ophthalmologist or optometrist.

Sjögren’s syndrome. Sjögren’s syndrome affects 10-25 percent of people living with RA, mostly women. It’s an inflammatory condition that can affect many parts of the body, but especially the salivary and tear glands, causing very dry mouth and eyes. This can lead to complications, such as ulcerations and increased need for root canals.

Lung health. One of the most serious systemic effects of RA is on the lungs. People with RA can develop a number of different lung conditions, such as pulmonary nodules and fluid between the lungs and the chest wall. As well, approximately ten percent develop Interstitial Lung Disease.

Infections. People with RA are also at risk for infections, with pneumonia being the number one cause of death due to infection. It’s crucial to get the pneumonia vaccine. Serious infections can be caused by the severity of RA, taking immunosuppressant drugs, cardiovascular disease, and comorbidities such as diabetes, and conditions affecting the heart, kidneys, and lungs.

Thyroid disease. People with RA are more likely to develop hypothyroidism (Hashimoto’s thyroiditis) or hypothyroidism (Graves’ disease). In North America, as many as 10 percent of people with RA have thyroid disease, some of which is autoimmune, some of which is not.

Lymphoma. As if all these other conditions weren’t enough, RA is also associated with an increased risk of lymphoma, particularly non-Hodgkin’s and B-cell lymphomas, especially with more severe cases. It is important to know that it is a small risk, however.

This is not an exhaustive list, but rather the more common or serious comorbidities and complications. I know that you’re feeling quite anxious right now, but it’s important to know that developing these conditions is a possibility, not a certainty. As so many of these complications and comorbidities are directly connected to inflammation and severity of inflammation, the best way of managing the risk is to treat your RA.

It’s also important to have an ongoing dialogue, not only with your rheumatologist, but also your family doctor about managing the risks of these conditions. Often RA can take up so much room that it blocks out other parts of your health, including preventative care. It’s called diagnostic overshadowing.

By becoming empowered and advocating for your own health, you can make certain that this doesn’t happen. Even if you develop one of these conditions, the earlier it’s caught, the better effects that treatment will have.

See More Helpful Articles:

Extra-Articular or Systemic Manifestations of RA

10 Tips for Managing Infection Risk

A Beginner’s Guide to RA: How to Be a Self-Advocate


Lene writes the award-winning blog The Seated View. She’s the author of Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.

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