RA Impacts Much More than Bones and Joints

RA Impacts Much More than Bones and Joints

When people hear the general term arthritis, they typically think of an older person with joint pain as in osteoarthritis – common wear and tear on the joints. But this term can miss the mark when describing the systemic impact of autoimmune rheumatoid disease on the entire body. One of the first symptoms that doctors often examine for establishing a diagnosis of RA is bone erosion – typically in the fingers. But as an autoimmune disease, RA can impact much more than the bones as it can damage a variety of soft tissues including the eyes (iritis), lungs (fibrosis), heart, blood vessels (vasculitis), nerves (carpal tunnel), and skin (nodules, ulcers), and connective tissue (cartilage, tendons, ligaments) (see https://rheumatoidarthritis.net/symptoms/). Often-times, the soft tissue damage occurs long before bone erosion is visible or even before an official RA diagnosis comes.

Besides bone erosion, RA can impact other parts of the joint including the surrounding connective soft tissues comprised of tendons, ligaments, and cartilage. Chronic tenosynovitis, inflammation of the sheath of a tendon, is common in rheumatoid arthritis and can result in the permanent damage and tearing of the involved tendons. Such tendon problems caused by RA are well known by the scientific community and are linked to joint deformities.1, 2 Tendon problems have even been posited as being one of the most powerful predictors of early RA.3 Sophisticated imaging techniques developed in the last few decades, such as MRIs and ultrasound, can reveal connective tissue damage in joints caused from RA that are not seen in x-rays.4 Bursitis, inflammation of the fluid-filled sacs that protect joints5, often accompanies tenosynovitis. RA is also implicated as a cause of cartilage damage in knees.4

In my particular RA case, damage to soft and connective tissue before bone damage to joints occurs is a typical presentation. Two symptoms now linked to RA which I personally experienced before an official diagnosis were iritis – inflammation in the eyes, and torn Achilles tendons and bursitis in my ankles resulting in three surgeries. An MRI taken at the onset of my RA diagnosis revealed cartilage damage in one knee. And just last week, an MRI revealed a 50% tear of a tendon in my elbow. The elbow joint, while actively inflamed, did not yet show bone erosions.

Although not publicly well known, scientists and doctors have recognized for some time that rheumatoid arthritis is also linked to an increased risk for cardiovascular disease (CVD) including heart attack, stroke, and diabetes. Systemic inflammation inherent in rheumatoid arthritis may play a role in the increased CVD risk.7 Some researchers have even called for the development of specific CVD predictors for RA patients as a special population with unique characteristics.8 Systemic inflammation involved with RA can impact the complex metabolic processes of the body including use of food for energy, sugar processing, insulin production, production of fats and lipids, body weight, and physical activity. Whenever one of these interconnected systems gets out of normal parameters, a cascade of problems may occur which can impact cardiovascular health. This is called metabolic syndrome and involves a set of interconnected risk factors which are related to cardiovascular disease and diabetes.9 In a study published in 2013, it was found that 18-49% of RA patients also had metabolic syndrome which was significantly higher than general populations.10 These researchers also found that RA patients with higher inflammatory blood markers and those who used corticosteroids were more likely to show signs of metabolic syndrome leading to increased cardiovascular risk which can have serious and fatal consequences.

As an autoimmune disease, RA can cause the body to attack itself in many different ways – not just in bones and joints. RA patients and doctors need to be aware of the numerous extra-articular (outside the joint) manifestations of the disease, carefully monitor them, and treat as needed. The stereotype of RA as “just arthritis” needs to be challenged and it needs to be seen as a hideous disease that can attack many different tissues and systems in the body.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. http://www.jhandsurg.org/article/S0363-5023(07)00777-0/abstract
  2. http://onlinelibrary.wiley.com/doi/10.1002/art.23016/full
  3. http://rheumatology.oxfordjournals.org/content/48/8/887.full
  4. http://www.ajronline.org/doi/abs/10.2214/AJR.07.2548
  5. http://www.nlm.nih.gov/medlineplus/bursitis.html
  6. http://orthoinfo.aaos.org/topic.cfm?topic=a00212
  7. http://ard.bmj.com/content/70/1/8
  8. http://ard.bmj.com/content/69/Suppl_1/i61.abstract
  9. http://www.nhlbi.nih.gov/health/health-topics/topics/ms/
  10. http://www.biomedcentral.com/1471-2474/14/147

    Comments

    View Comments (7)
  11. elisee55
    2 years ago

    It’s always interesting to hear what others go through with this disease. I recently had Xrays to rule out TB in conjunction with the regular blood tests etc. I have definite lung shadowing, which has no explanation. I would like one, but no one seems particularly concerned. And just yesterday I was told I have developed a ‘new left bundle branch block’ that was not there two years ago. Now I’m really nervous about what is going on with my body. I will have to have a work up done to find out why this new symptom happened. Cardiovascular issues scare me. I realize that not everything is connected to the RA, but even if it isn’t, having another diagnosis on top of all the others I have means that my body is betraying me. I’m not overweight. I don’t have high blood pressure or high cholesterol levels. I don’t smoke. And I thought I looked after myself. It’s quite disappointing and also quite distressing.all

  12. Sue Ervin
    4 years ago

    I was diagnosed in early 1995, I have never been in remission. I tried Enbrel and about 7 months on it I started having respiratory problems. A few months later I had an empyema (sp?) And nearly died. I had a wedge excised from the upper lobe of right lung. My lungs are full of nodules. Five years later I got bronchitis then started coughing up blood. After biopsies and all kinds of test, I had 2 nodules removed from lower lobe of left lung. Still no answers. The pulmonologist says not like Rhuematoid nodules he’s seen before, and none of colleagues know either. My last CT shows another module cavitating, so again it’s wait and see and more tests. He’s calling it necroizing granuloma.

  13. Andrew Lumpe, PhD moderator author
    4 years ago

    Wow Sue, sorry you’ve been through such a hard time. I hope they figure it out and that these nodules stop occurring.

  14. slywy
    4 years ago

    This is good if depressing information. My rheumatologist basically tracks metabolic levels to see how the meds are affecting liver/kidney function, but doesn’t check inflammation levels. My initial levels were off the scale but I’m supposed to be stable (and I’m pretty functional — I have more back pain from stenosis than anything else, and fatigue).

    One suggestion — fix spelling of “carpel” to “carpal.” 🙂

  15. Annette
    5 years ago

    That’s a very realistic article. Thanks Andrew

    It’s been a long time since my diagnosis and I’m beginning to feel that I am falling aprt in a sense. My doctor feels that my RA is a 2 out of 10 on the activity scale so doesn’t need agressive treatment, and yet my jaw joints show severe degeneration which is “not RA”.
    I have some friends with long term RA and they and I are having digestive problems. Sjogren’s is part of my experience too and I would say that all of these unwanted results are beyond interesting. There are very few good ares left.

  16. Shirley Sanders
    4 years ago

    I am interested to see the mention of digestive issues. I just suffered from renal insufficiency which the doctors felt was caused by Arava. My system has been drastically changed since this event.I do not have colitis or crohns. disease. I no longer am on any medications for the RA as I get way too many infections.I would love to see more articles on the digestive issues as a complication of RA.

  17. Andrew Lumpe, PhD moderator author
    5 years ago

    Hi Annette,
    RA is a systemic disease that can impact many parts of the body including the jaw joint. On the other hand, not every symptom can be attributed to RA. Have you thought about getting a second opinion from another rheumatologist?
    Thanks for reading.
    Andrew

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