Complications
Rheumatoid arthritis is not fatal, but complications of the disease may shorten survival by a few years in some individuals. Although type 2 rheumatoid arthritis is progressive and there is no cure, over time the disease becomes less aggressive and symptoms may even improve. Treatments for RA are increasingly effective in slowing down this debilitating disease, and some may even prevent initial destruction by aggressively reducing inflammation. If bone and ligament destruction and any deformities have occurred, however, the effects are permanent. It is essential, therefore, to seek a physician's help as soon as symptoms develop. Side effects of the treatments often contribute to the severity of the disease.
Effect of Joint Disability and Pain on Daily Life
Affected joints can become deformed, and the performance of even ordinary tasks may be very difficult or impossible. According to one survey, 70% of patients with rheumatoid arthritis feel the disease prevents them from living a fully productive life. A 2000 study in England found that approximately one third of individuals stop working within five years of onset of the disease.
Complications in Other Areas of the Body
Rheumatoid arthritis can affect other parts of the body as well as the joints. Some patients with severe disease may then be at higher risk for complications such as the following:
- Peripheral Neuropathy. This condition affects the nerves, most often those in the hands and feet. It can result in tingling, numbness, or burning.
- Anemia.
- Scleritis. This is an inflammation of the blood vessels in the eye that could result in corneal damage.
- Infections. RA patients have a higher risk for infections, particularly from some of the immune-suppressing drugs that they take.
- Skin problems. 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 under the skin, and other problems. Severe skin disease can reflects a more serious case of RA in general.
- Gastrointestinal Problems. Although patients may experience stomach and intestinal distress, one 2000 study reported lower rates of stomach and colorectal cancers among RA patients.
- Osteoporosis. Osteoporosis, a disorder in which bone density decreases, is more common than average in postmenopausal women with rheumatoid arthritis. The hipbone is particularly affected. The risk for osteoporosis also appears to be higher than average in men with RA who are over 60 years old.
- Lung Disease. One small study found a very high prevalence of lung disease in newly diagnosed RA patients. The association between a history of smoking and a higher risk for RA, however, may at least partially account for this finding. (Cigarette smoking, in any case, may increase the severity of the disease.)
- Heart Disease. Mounting evidence suggests that RA can increase the risk for heart disease, possibly because of the inflammatory response in RA, which may also injure arteries and heart muscle tissue. Some studies have reported that people with RA are 30% to 50% more likely to suffer heart vessel blockages and 60% to 70% more likely to die as result than people without RA. A smaller British study confirmed that about half of RA patients are likely to have silent symptoms of heart disease, and that it tends to develop about 10 years earlier than in people without RA.
- Lymphoma and Other Cancers. Alterations in the immune system associated with RA and certain treatments may play a role in the higher risk for lymphoma observed in RA patients. A higher risk for lymphoma and blood cancers may also occur in patients who were given total lymphoid irradiation, an RA therapy used mainly in the 1980s when other therapies failed. Aggressive treatments for RA that suppress the immune system may help prevent such cancers, but more research will be needed to evaluate this possibility. Other cancers that may occur with increased frequency in RA patients include prostate and lung cancers.
- Periodontal Disease. People with RA may be twice as likely as non-arthritic individuals to have periodontal disease. Chronic inflammation and immune dysfunction are central to both diseases.
Severity of Juvenile Rheumatoid Arthritis
Juvenile rheumatoid arthritis often resolves before adulthood. Patients who experience arthritis in only a few joints do better than those with more widespread (systemic) disease, which is very difficult to treat. Although it can be very serious, morality rates are 0.29% (33 deaths in 11,287 patients).
MAS. Macrophage activation syndrome (MAS) is a life-threatening complication of this disorder and requires immediate treatment with high-dose steroids and cyclosporin A. Parents should be aware of symptoms, which include persistent fever, weakness, drowsiness, and lethargy.
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