Symptoms and Complications of Rheumatoid Arthritis (RA)

Overview Cardiac Eyes Fatigue Hearing Joints —Bone Density

—Swan Neck Deformity Neuropathy Psychological Pulmonary Renal Vascular Complications

Overview

Although rheumatoid arthritis is often thought of as a disease that affects only the joints, it is actually a systemic disease, which means that it can affect nearly any part of the body.

Common symptoms include fatigue, weakness, muscle pain, reduced appetitie as well as heart, kidney, lung, and vascular problems.

Symptoms of Rheumatoid Arthritis. The disease usually begins gradually with fatigue, morning stiffness (lasting more than one hour), widespread muscle aches, loss of appetite, and weakness. Eventually, joint pain appears. When the joint is not used for a while, it can become warm, tender, stiff, and swollen. Joint pain is often felt on both sides of the body, and may effect the wrist, knees, elbows, fingers, toes, ankle or neck. Medline Plus.

High prevalence of widespread pain (WP) in women with early rheumatoid arthritis (RA). A significant group of women with early RA experience WP with a high DAS28 and increased pain intensity level. PubMed, Scand J Rheumatol, 2018 Jul 5:1-8.

Cardiac Involvement

Heart Disease and Rheumatoid Arthritis. Rheumatoid arthritis almost doubles the risk of having a heart attack within the first 10 years of getting an RA diagnosis. WebMD.

Association of cardiovascular disease (CVD) and traditional cardiovascular (CV) risk factors with the incidence of dementia among patients with rheumatoid arthritis (RA). Patients with RA with both CVD and CV risk factors alone are at an increased risk for dementia compared to those with neither CVD nor CV risk factors. Seminars in Arthritis and Rheumatism, 01/05/2021.

Beta–2–glycoprotein–I IgA antibodies predict coronary plaque progression in rheumatoid arthritis. Anti-β2GPI IgA addition to clinical risk models improved prediction accuracy of coronary artery calcium, plaque progression and transition to extensive/obstructive disease. Seminars in Arthritis and Rheumatism, 12/17/2020. (Also see Antibodies)

Outcomes of Percutaneous Coronary Intervention (PCI) in Patients With Rheumatoid Arthritis (RA). Patients with RA who underwent PCI had more co-morbidities and longer, complex coronary lesions. PubMed, Am J Cardiol, 2020 Nov 2;S0002-9149(20)31181-4.

Differences in HDL-Cholesterol Efflux Capacity (CEC) Between Patients with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA). RA patients have a more pro-atherogenic lipid pattern compared to those with SLE. However, CEC seems to be more damaged in SLE than in RA patients. PubMed, Arthritis Care Res (Hoboken), 08/08/2020. (Also see Symptoms and Complications of Lupus)

Subclinical atherosclerosis in systemic sclerosis (SSc) and rheumatoid arthritis (RA): a comparative matched-cohort study. The results of this comparative study show that subclinical atherosclerosis is comparable between SSc and RA, a systemic disease with well-defined high atherosclerotic burden. PubMed, Rheumatol Int, 08/08/2020. (Also see Cardiac (Heart) Involvement)

Anti-citrullinated Protein Antibody (ACPA) Specificities, Rheumatoid Factor (RF) Isotypes and Incident Cardiovascular (CV) Events in Patients With Rheumatoid Arthritis. RF isotypes and ACPA are associated with future CV events. PubMed, Arthritis Rheumatol, 05/31/2020.

Comparative Risk of Cardiovascular Events (MACE) With Biologic and Synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs) in Patients With Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Based on meta-analysis, as compared to tumor necrosis factor inhibitors, tocilizumab may be associated with a reduced risk of MACE, whereas csDMARDs may be associated with an increased risk of MACE and stroke. PubMed, Arthritis Care Res (Hoboken). 2020 Apr;72(4):561-576. (Also see DMARDs)

Comparison of Receptor Activator of Nuclear Factor Kappa B Ligand (RANKL) expression, inflammatory markers and cardiovascular risk in patients with acute coronary syndrome (ACS) with and without rheumatoid arthritis (RA). Our results indicate that exRANKL, inflammatory markers and mortality risk are amplified in ACS patients with RA compared to ACS patients without RA. PubMed, Rheumatol Int, 07/11/2019.

Siblings of patients with rheumatoid arthritis (RA) are at increased risk of acute coronary syndrome (ACS). Siblings of patients with RA are at increased risk of ACS, suggesting shared susceptibility between RA and ACS. PubMed, Ann Rheum Dis, 02/20/2019.

Diastolic dysfunction (DD) in rheumatoid arthritis (RA) patients with low disease activity. The prevalence of DD as expressed by E/A ratio in RA patients with continued low disease activity was not different from that of controls. PubMed, Clin Rheumatol, 12/12/2018.

Elevated levels of plasma symmetric dimethylarginine and increased arginase activity as potential indicators of cardiovascular comorbidity in rheumatoid arthritis (RA). This dysregulated L-arginine metabolism may function as a potential indicator of cardiovascular disease risk in patients with RA. PubMed, Arthritis Res Ther, 2018 Jun 8;20(1):123.

Novel gene variants associated with cardiovascular disease (CVD) in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). The IL19 risk allele was associated with stroke/MI in SLE and RA, but not in the general population, indicating that shared immune pathways may be involved in the CVD pathogenesis in inflammatory rheumatic diseases. PubMed, Ann Rheum Dis, 03/07/2018. (Also see Symptoms and Complications of Lupus)

Subclinical impairment of myocardial and endothelial functionality in very early psoriatic (PsA) and rheumatoid arthritis patients: Association with vitamin D and inflammation. Disease activity was the main predictor of myocardial strain impairment and myocardial function was altered and associated with carotid intima-media thickness. Atherosclerosis, 03/06/2018. (Also see Psoriasis and Psoriatic Arthritis)

Eye Involvement

Can rheumatoid arthritis affect the eyes? Eye conditions associated with rheumatoid arthritis may include dry eyes, uveitis, scleritis, glaucoma and cataracts. Mayo Clinic.

Fatigue

Management of Fatigue in Rheumatoid Arthritis. More research is needed to understand fatigue and how to treat this common complex symptom in RA that can be the worst symptom for some patients. PubMed, RMD Open, 2020 May;6(1).

Association between vitamin D and fatigue in patients with rheumatoid arthritis (RA): a cross-sectional study. This cross-sectional study found no evidence of association between vitamin D and fatigue in patients with RA. PubMed, BMJ Open, 2020 Feb 6;10(2):e034935. (Also see Vitamin D)

Factors of importance for reducing fatigue in persons with rheumatoid arthritis: a qualitative interview study. The participants in this study expressed that physical activity was important in handling fatigue, but also that this insight could only come from personal experience. PubMed, BMJ Open, 2019 May 29;9(5):e028719.

Hearing

Effect of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) on sudden sensorineural hearing loss (SSNHL). Comorbid SLE or RA may negatively affect the prognosis of SSNHL. PubMed, Laryngoscope, 12/04/2019. (Also see Symptoms and Complications of Lupus and Autoimmune Ear Diseases)

Joints

Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment. PubMed, Ann Rheum Dis, 2021 Jan 12;annrheumdis-2020-218744. (Also see Psoriasis and Psoriatic Arthritis)

Bone Density

Micro-structural bone changes are associated with broad-spectrum autoimmunity and predict the onset of rheumatoid arthritis (RA). Microstructural changes in RA at-risk individuals are associated with broad-spectrum autoimmunity and predict the onset of RA. PubMed, Arthritis Rheumatol, 02/18/2020.

Opportunistic screening for osteoporosis using thoraco-abdomino-pelvic CT-scan assessing the vertebral density in rheumatoid arthritis patients. CT offers a combined opportunistic screening for osteoporosis by assessing both vertebral fractures and bone density on routine CT-scans. PubMed, Osteoporos Int, 2019 Jun;30(6):1215-1222. (Also see Osteoporosis)

Swan Neck Deformity

Drawing of Swan Neck Deformity. Netter Images.

Computer-Based Radiographic Quantification of Joint Space Narrowing (JSN) Progression Using Sequential Hand Radiographs: Validation Study in Rheumatoid Arthritis (RA) Patients from Multiple Institutions. The proposed computer–based method provides quantitative measurement of JSN progression using sequential hand radiographs and may be a useful tool in follow–up assessment of joint damage in RA patients. PubMed, J Digit Imaging.

Neuropathy

Neuropathy Causes And Treatments. Autoimmune diseases such as lupus and rheumatoid arthritis also increase one's chance of developing a neuropathy. Medical News Today.

Inflammation is associated with pro-nociceptive brain connections in rheumatoid arthritis (RA) patients with concomitant fibromyalgia (FM). Here we provide the first neurobiological evidence that comorbid FM in RA may be linked to peripheral inflammation through pro-nociceptive patterns of brain connectivity. PubMed, Arthritis Rheumatol, 08/05/2019. (Also see Fibromyalgia)

Association between serum vitamin D levels and neuropathic pain (NP) in rheumatoid arthritis (RA) patients: A cross–sectional study. Although further research is needed to clarify the association between serum vitamin D levels and NP, our study raises awareness of the need to screen for vitamin D deficiency in RA patients with NP. PubMed, Int J Rheum Dis,2018 Feb;21(2):431-439. (Also see Vitamin D Deficiency)

Psychological Factors

Rheumatoid Arthritis (RA): The Impact of Mental Health on Disease: A Narrative Review. It is important to determine the most appropriate tool to monitor mental health well-being and quality of life of RA patients in rheumatology outpatient clinics. PubMed, Rheumatol Ther, 06/13/2020. (Also see Depression)

The Impact of Tocilizumab (TCZ) on Anxiety and Depression in Patients With Rheumatoid Arthritis (RA). This study has demonstrated a favourable impact of TCZ therapy on parameters reflecting depression and anxiety severity in patients with RA. PubMed, Eur J Clin Invest, 2020 Jun 1;e13268. (Also see Clinical Trials and Depression)

Immune responses to stress in rheumatoid arthritis (RA) and psoriasis. Patients with RA have a different immune response to stress than patients with psoriasis or healthy controls. More needs to be learned about the complex interaction between stress, immune parameters and chronic inflammation. PubMed, Rheumatology (Oxford). (Also see Psoriasis, and Stress)

Pulmonary (Lung) Involvement

Rheumatoid arthritis–related lung disease detected on clinical chest computed tomography imaging: Prevalence, risk factors, and impact on mortality. RA–related lung disease was commonly detected on chest CT imaging regardless of RA serostatus. Seminars in Arthritis and Rheumatism, 09/28/2020.

Respiratory diseases as risk factors for seropositive and seronegative rheumatoid arthritis and in relation to smoking. Respiratory diseases increase the risk for both seropositive and seronegative RA, but only among nonsmokers. PubMed, Arthritis Rheumatol, 08/16/2020.

Predicting outcomes in rheumatoid arthritis related interstitial lung disease (RAILD). The combination of two visual computed tomography–based staging systems identified 23% of an RAILD cohort with an IPF–like progressive fibrotic phenotype. PubMed, Eur Respir J, 11/28/2018.

Clinicopathological features of lung cancer (LC) in patients with rheumatoid arthritis (RA). Lower likelihood for receiving surgery, radiotherapy, chemotherapy and targeted therapy was reported for LC patients with RA. Journal of Thoracic Disease, 08/02/2018. (Also see Cancer)

Renal (Kidney) Involvement

Clinicopatological variants and risk factors for chronic kidney disease (CKD) in rheumatoid arthritis (RA). The risk factors for CKD in patients with RA are activity and duration of the disease In addition to common population factors. PubMed, Ter Arkh, 2020 Jun 5;92(5):55-60.

Risk of incident liver disease in patients with psoriasis (PsO), psoriatic arthritis (PsA) and rheumatoid arthritis (RA): a population–based study. More so than RA, PsO and PsA are associated with liver disease, particularly non-alcoholic fatty liver disease and cirrhosis, and this was true even among patients without systemic therapy exposure. PubMed, J Invest Dermatol, 2018 Apr;138(4):760-767. (Also see Psoriasis and Psoriatic Arthritis)

Swan Neck Deformity

Swan Neck Deformity is a classic feature of rheumatoid arthritis that is related to laxity and instability of the joint as the rheumatoid lesion destroys the supporting tissues. It is almost never seen in systemic scleroderma (SSc) unless it is in overlap with rheumatoid arthritis (RA).

Vascular Involvement

Risk of venous thromboembolism (VTE) in rheumatoid arthritis (RA), and its association with disease activity: a nationwide cohort study from Sweden. This study demonstrates a strong association between clinical RA disease activity measured by Disease Activity Score 28 erythrocyte sedimentation rate and the risk of VTE. PubMed, Ann Rheum Dis, 10/08/2020.

Effect of Methotrexate Use on the Development of Type 2 Diabetes in Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis. Rheumatoid arthritis patients on methotrexate treatment had a lower risk of developing type 2 diabetes compared to rheumatoid arthritis patients not exposed to methotrexate. PubMed, PLoS One, 2020 Jul 6;15(7):e0235637. (Also see Immunosuppressants)

Association of galectin-3 with markers of myocardial function, atherosclerosis and vascular fibrosis in patients with rheumatoid arthritis (RA). Serum galectin-3 might be useful as a marker of cardiac function and cardiovascular fibrosis in RA patients with low–grade systemic inflammation and long–standing disease. PubMed, Clin Cardiol, 10/23/2018.

Vascular calcifications on hand radiographs in rheumatoid arthritis (RA) and associations with autoantibodies, cardiovascular risk factors and mortality. Vascular calcifications on hand radiographs were independently associated with increased all-cause mortality in RA. PubMed, Rheumatology (Oxford).

Complications Due to Rheumatoid Arthritis

Assessing Associations of Synovial Perfusion, Cartilage Quality, and Outcome in Rheumatoid Arthritis (RA) Using Dynamic Contrast-enhanced Magnetic Resonance Imaging. Synovial perfusion relates to remission, response, and cartilage quality in a cohort of therapy-naive patients with early RA. PubMed, J Rheumatol, 2020 Jan;47(1):15-19.

Association between pain phenotype and disease activity in rheumatoid arthritis patients: a non-interventional, longitudinal cohort study. This longitudinal study showed consistently worse long-term disease activity outcomes in RA patients. PubMed, Arthritis Res Ther, 2019 Nov 29;21(1):257.

The association between lymphopenia and serious infection (SI) risk in rheumatoid arthritis (RA). Lymphocyte counts below 1.0 × 109 cells/l were associated with higher SI risk in RA patients and may be used as a measure to stratify patients at risk of SI. PubMed, Rheumatology (Oxford), 08/27/2019.

Incidence and patterns of malignancies in a multi-ethnic cohort of rheumatoid arthritis (RA) patients. There is a trend toward an overall increased malignancy risk in our RA patients compared to the general population. PubMed, Int J Rheum Dis, 07/11/2019.

Rheumatoid arthritis patients' oral health and disease activity. Cooperation between rheumatologists and dentists is important in oral health management in periodontal inflammation. PubMed, Int J Rheum Dis, 05/07/2019. (Also see Periodontal Disease)

Prevalence of and factors associated with dysfunctional low back pain in patients with rheumatoid arthritis. Strictly controlling patients' body weight and disease activity with methotrexate and avoiding spinopelvic malalignment through vertebral fracture prevention are important. PubMed, Eur Spine J, 03/08/2019.

High Burden of Sexual Dysfunction in Female Patients (FSD) with Rheumatoid Arthritis (RA): Results of a Cross–sectional Study. FSD apparently is highly prevalent in female patients with RA, affects all subdomains of sexual function, and is most likely underestimated in daily clinical practice. PubMed, J Rheumatol, 2019 Jan;46(1):19-26. (Also see Female Sexual Dysfunction)

miR-210 expression in PBMCs from patients with systemic lupus erythematosus and rheumatoid arthritis. The dysregulation of miR-210 levels in SLE and RA patients suggests that miR-210 might play an important role in the pathogenesis of these diseases. PubMed, Ir J Med Sci,2018 Feb;187(1):243-249. (Also see Lupus Research)

Case Report: Antiphospholipid syndrome (APS) in a patient with rheumatoid arthritis (RA). We report a case of APS manifesting as cutaneous ulceration and necrosis in a patient with severe RA. PubMed, Cutis. (Also see Antiphospholipid Syndrome)

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