How to Manage Rheumatoid Arthritis Complications

M.A., Health Writer
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When you think about RA complications, remember to think of them two ways, suggests Lindsay S. Lally, M.D., rheumatologist at the Hospital for Special Surgery in New York City. She's also assistant professor of medicine at Weill Cornell Medical College. "There are complications from the disease itself — being untreated or inadequately treated — and there are joint complications that can cause permanent damage." Dr. Lally discusses RA complications, what they mean to you, and how to treat them.


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Assessing joint damage

Doctors use X-rays to view erosions, where inflammation has "eaten away" at bone. "Clinically, that translates to a possible permanent loss of function of certain joints," Dr. Lally says. "So our rationale for treating is twofold. We want patients to feel better, for pain and stiffness to go away, and we want to prevent joint damage. Good news: Routinely-used therapies effectively manage pain and inflammation, and are disease-modifying at the joint level, preventing damage and disability."


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Earlier rather than later

Doctors typically like to start treatment early, but treatments may involve medications that lower or suppress the immune system somehow, says Dr. Lally. "The immune system has been overactive, and then medications present us with a host of potential related side effects. Yes, these drugs can be life-changing in a good way, but side effects require appropriate use and close monitoring. The biggest concern is infection, so we take special care to try and prevent that."


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The good news about complications

As effective treatments for RA have progressed, the extent of complications has changed, Dr. Lally says, and in general, it's good news. "We don't really see a lot of neuropathy or nerve damage anymore. In addition, we don't see so much vasculitis or blood vessel inflammation. These both were part of a group of more severe complications that were more prominent before we had so many newer, effective therapies."


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Heart disease and RA

"Studies have shown for a long time that there's a higher risk for heart disease and stroke in patients with RA than in the general population," says Dr. Lally. That means RA treatment also focuses on reducing the risks of heart disease, which means controlling obesity, high cholesterol, high blood pressure, and diabetes. "Some conditions can worsen due to RA therapies, so it's important that patients be closely monitored on the right therapy for them."


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About those medications

Doctors must maintain a delicate balance between achieving remission and stopping more joint damage, while keeping side effects at bay. The majority of patients with RA take a disease-modifying antirheumatic drug or DMARD, which can include biologics that do increase potential for infection in some people. Many RA patients also take nonsteroidal anti-inflammatory drugs or NSAIDs; glucocorticoids, a.k.a., steroids; or other analgesics such as acetaminophen.


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Osteoporosis and RA

People with RA are at higher risk for osteoporosis, says Dr. Lally. The National Institutes of Health (NIH) cite studies that confirm increased risk of bone loss and fracture. Glucocorticoid medications used in treatment can trigger significant bone loss, says the NIH. It's cyclical: Pain and loss of joint function cause inactivity, raising osteoporosis risk. Finally, studies show bone loss occurs just because of the disease. Good nutrition, exercise, and a healthy lifestyle help slow disease progression.


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Interstitial lung disease (ILD) and RA

Patients with RA are at an increased risk for interstitial lung disease (ILD), which can be the result of the disease itself or from some therapies used to treat RA. There are many different subtypes of pulmonary involvement and ILD in RA. Collaboration between rheumatologists and pulmonologists is essential to make the right diagnosis and to formulate a treatment plan. In addition to immunosuppressive medications, ILD patients may also require oxygen therapy and pulmonary rehabilitation.


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About RA-related ILD treatment

A study in the August 2017 edition of the journal Rheumatology found that the biologic medication, rituximab, may be a good treatment choice for people who have RA-related ILD. The patient group received the drug for arthritis. Lung function remained stable or improved in most patients after rituximab use over a prolonged follow-up period.


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RA and eye disease

It's well known that arthritis causes joint inflammation, and that people with arthritis can develop inflammation in other areas of the body, Dr. Lally says. The eyes aren't immune and can develop a range of conditions from dry eye syndrome, scleritis, and episcleritis, to peripheral ulcerative keratitis, uveitis, cataracts, and even glaucoma. See HealthCentral's complete slideshow about RA and eye conditions.


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Take care of you

Your diligent self-care, in coordination with your doctor, may help prevent some complications.

The Arthritis Foundation recommends you consider an anti-inflammatory diet, balancing activity with rest, physical activity (exercise), heat and cold treatments, topical treatments, some natural and alternative therapies, supplements, and that you maintain a positive attitude and support system. Being proactive about your condition may benefit you in so many ways.