The Complications of Rheumatoid Arthritis
No one ever plans for a chronic illness. We plan on going to college, being successful in our careers, finding love, having kids and raising them to be great and retiring comfortably.
But developing rheumatoid arthritis (RA) is not our list of things to do with our lives. Unfortunately, for some of us, it happened, and RA hijacked our once normal lives.
It feels like as soon as RA takes it hold of you, it never lets you go. That is because RA affects every single part of your life down to the little details.
So, how do the complications of rheumatoid arthritis affect our lives?
Everyone is Different
The complications of rheumatoid arthritis affect people differently. Some people have a milder form of the disease with periods of flares, where symptoms worsen, and periods of remission, where symptoms are gone or minimal.
Some with RA have a more severe form of the disease where RA fatigue and pain are experienced on most days. For these people, persistent inflammation leads to joint damage, disease complications, and disability.
RA is primarily a joint disease, but its symptoms are not just physical. Many people with RA have problems with depression and anxiety.
Emotional problems arise because RA invades every part of your life from home life to work. RA gets in the way of family responsibilities and even in the decision to have children.
The good news is RA is a manageable disease, and most newer RA medications allow help people to continue to be productive and functioning. These medicines help with pain and slow down joint damage.
Other treatment strategies, including exercise, eating healthy, patient education and support also help you to manage RA. And new research on how RA works is helping researchers better understand how to treat the disease better, and this leaves more room to be hopeful.
The Physical Complications of Rheumatoid Arthritis
RA is a systemic disease, which means it involves your entire body and can cause damage to joints and major organs. It can even shorten your life if not managed properly.
The earlier you begin treating for RA with medication, the better your chances are for stopping joint damage, protecting your organs and having a longer life without disability and physical pain.
The Physical Complications of Rheumatoid Arthritis
Joints and Muscles
Persistent inflammation can cause joint damage and deformities, especially in your hands and feet. Additionally, because RA causes bone loss, it puts you at higher risk for osteoporosis.
RA also causes damage the muscles surrounding the joints. Muscle atrophy results from ongoing inflammation and not using muscles due to pain.
Skin, Eyes, and Mouth
Small hard lumps, called nodules, caused by inflammation may develop on or near the joints. Skin ulcers and patches may result from inflammation of blood vessels.
Studies show at least a quarter of the people with RA also have secondary Sjogren’s syndrome. Sjogren’s causes severe dryness, especially in the eyes, mouth, and throat.
Dryness caused by Sjogren’s can lead to eye complications, difficulty swallowing and tooth and mouth problems. Some people experience swollen neck and face glands, dry nasal passages and dry skin and women may have virginal dryness.
Cardiovascular
Too much inflammation around the heart can lead to a serious condition called pericardial effusion. This is where abnormal amounts of fluid build-up around the heart and put pressure on the heart, causing poor function.
If left untreated, pericardial effusion can lead to heart failure and/or death.
RA inflammation can also affect muscles, valves and blood vessels of the heart. According to the Arthritis Foundation, RA doubles the risk of heart problems, including stroke and heart attack.
Blood Vessels
Blood vessel inflammation may cause a condition called vasculitis, often seen in people with advanced RA. Vasculitis is a sign your RA is severe and more aggressive therapies are needed to get it under control.
Anemia
Uncontrolled inflammation can cause a reduction in red blood cells leading to anemia. Treatment requires controlling inflammation and iron supplements to normalize red blood cell counts.
Lungs
RA can scar the lungs, cause fluid buildup in the chest and promote nodule growth in the lungs. Warning signs of lung problems include a cough, shortness of breath and chest pain.
Higher Risk for Infection
People with are RA are more susceptible to infection because their immune systems attack healthy tissues rather than fighting off invaders and because of harsh medications used to treat the disease.
The Emotional Health Complications of Rheumatoid Arthritis
Having a long-term illness like RA is emotionally demanding. After overcoming the initial shock, daily challenges increase your risk for depression and anxiety and bring stress to your life.
In fact, according to one report in the International Journal of Clinical Rheumatology, up to 42% of people with RA experience significant depression, which leads to worsening symptoms and pain, higher disease activity and poor overall health.
Inflammation and pain are triggers to depression, but so are feelings of worry and fear about your health and how you will live with RA for the rest of your life.
Managing and Coping with RA
Despite the difficulties RA presents, it is a manageable condition, and it is possible for you to live a good quality life with this disease.
It is also possible to slow down the progression of RA and treat the symptoms, with a combination of drug treatments, lifestyle changes, and physical therapy.
For some people, surgery might become necessary to restore function in joints that have become severely damaged and causing extreme pain.
You can also manage your emotional health by practicing a positive attitude and having a network of support that includes family and friends and even a therapist to help you cope with RA challenges and pain.
Medicinal Treatment
While there is no cure for RA, newer biologic and disease-modifying antirheumatic drugs (DMARDs), help many people continue to live healthy and active lives.
The are several main goals for RA treatment:
- Stop inflammation and potentially put the disease in remission
- Relieve symptoms
- Prevent joint damage and disability
- Improve function and quality of life
For these goals to be possible, your doctor will want to focus on a number of things:
- Early and aggressive treatment to manage inflammation
- Targeting remission – RA remission means little or no signs of the active disease inflammation
- Getting disease activity to low levels and keeping it there
The medications your doctor will recommend for treating RA depend on the severity of symptoms and how long you have had the disease. Some RA medications treat and ease RA symptoms while others slow down or stop the disease from damaging joints and causing other complications.
But these rheumatoid arthritis medications come with side effects, and for many of us with RA, we begin to realize the benefits outweigh the risks.
RA Medications
- Disease-modifying antirheumatic (DMARDs). DMARDs slow down the progress of RA to save joints and other tissues from permanent damage from inflammation. The most common DMARD is methotrexate, which has been used to treat RA since 1985.
- Methotrexate. One of the safest RA drugs, but it has side effects, including elevated liver enzymes. Taking folic acid can help relieve some of the side effects. Complications of methotrexate and other DMARDs include severe lung infections and liver damage.
- Biologic response modifiers. Biologic response modifiers, or biologics for short, include a newer type of DMARDs. These drugs target parts of the immune system that trigger inflammation. The medications are most effective when paired with non-biologic DMARDs, especially methotrexate. Because these medications suppress the immune system, they are associated with an increased risk of infection.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are designed to relieve pain and inflammation. Some of these are available over the counter and doctors can prescribe stronger NSAIDs. Like other medications used to treat RA, NSAIDs come with long term side effects, including possible kidney and liver damage and heart problems.
- Corticosteroids. Prednisone is the most commonly prescribed corticosteroid drug for reducing inflammation and pain and slowing down joint damage. But because these drugs pose very harsh side effects, including thinning of bones, doctors prescribe them in the short term.
Lifestyle Changes
Making appropriate lifestyle changes offers you an opportunity to take a proactive role in your health and overall quality of life.
Here are some of the ways to do that:
- Healthy Eating. There is no particular diet to follow with RA, but research has identified certain foods that can help reduce inflammation, including fatty fish, fruits, and vegetables. Moreover, some foods, especially processed and junk foods, promote inflammation and you can benefit from removing these from your diet.
- Activity. It can be difficult to be active when you hurt most of the time, but exercise is an important part of RA treatment. A physical therapist is in the best position to work with someone with RA and help them to find an exercise program that helps and won’t cause injury.
- Rest. When RA symptoms are active, and your joints feel painful, stiff and swollen, rest contributes to bringing down inflammation and fatigue. It is also important to take to conserve energy and protect joints even on the days where you feel better and stronger.
- Ditch the bad health habits. Smoking, drinking alcohol in excess, not being active, and missing doctor’s appointments are all things that will make living with RA harder.
Why You Need to Ditch the Bad Habits
One 2010 study from Japan finds the risk for RA is doubled for smokers and the heavier of a smoker you are, the higher your risk is. And smoking is associated with higher disease activity in people who already have RA, this according to one 2014 report in the International Journal of Molecular Sciences.
If you take medication for RA, regularly drinking can further worsen your health. RA drugs already increase your risk for liver problems, and adding alcohol can strain your liver even further.
Regular activity is an important part of your RA treatment plan, but only half of people with RA get enough exercise. If the pain is keeping you from being active, it is time to have a conversation with your doctor about getting your pain and inflammation under control.
Make sure you are seeing your rheumatologist several times a year and getting routine blood work done. You should also let your doctor know how treatments are going and if you have any active stressors in your life.
The Emotional Health Complications of Rheumatoid Arthritis
Managing Emotional Health
Living with RA means experiencing a whole host of emotions and these change day to day, depending on how you are feeling physically. These feelings can lead to low moods and depression.
Stress and depression make living with RA even harder so it is important to learn to cope with stressors and recognize the signs of depression. Most importantly, RA is challenging enough so don’t try to do it alone.
Stress
RA and stress can be a vicious cycle if we allow it. And stress leads to increased disease activity and more pain. Therefore, it is important to identify and manage the stressors in your life.
Depression
Recognizing depression and treating it is essential for overall well-being and managing RA.
Being depressed with RA causes many more symptoms:
- More pain
- Increased risk for heart attack
- Loss of productivity
- Struggles in personal relationship
- Decreased response to RA treatment
Moreover, people with RA whose depression is addressed have better health outcomes.
If you are depressed, do not try to convince yourself depression will go away on their own. Get the help you need and deserve.
Support
Living with RA can be lonely, so it is important to stay connected with people who can help you to cope.
Fortunately, there are many ways you can stay connected:
- Talk to others with the same illness. Sharing and learning from others who have similar concerns and fears about RA can help you to cope. You find a local support group in your area or try one of the many online support groups out there.
- Let loved ones help you. Many people in your life want to help you. Let them.
- Yes, there will be days where you don’t want anyone’s help or advice. And that is okay, but make sure you reach out when you can.
- Talk to a professional. There will be things about living with RA you may not want to share with loved ones or a support group. At that point, you may want to get in touch with a therapist who can listen and offer ideas to help you cope.
- Don’t do it alone. Because of the complications of rheumatoid arthritis, there will be days that are harder than others to get through. These are the times to remind yourself you are not alone, and that are people out there who get it, understand and want to help.
Coping Through a Flare
If you have RA, you should know what a flare-up is:
- Extreme joint pain
- Swelling and stiffness
- Debilitating fatigue
Flares happen even if your RA is controlled.
The good news is, there are many coping strategies you can use to help you through a flare:
- Reduce joint stress. During flares, your joints are painful so resting them is important. If you need to get around the house use a cane or walker to help get the weight off your stressed joints.
- Stretch. Lack of activity will make your joints stiffer and more painful. During a flare, you do not want to attempt any strenuous exercise, but stretching and other gentle activity may help you get through a flare.
- Manage stress. Stress contributes to flares, but there are some things you can during to manage stress during a flare, including practicing yoga, deep breathing or meditation, gentle massages, or taking warm baths.
- Eat right. While you should always aim to eat right with RA, it is even more important during a flare.
- Stay away from foods known for triggering flares, such as processed foods and sweets. Eat foods that help bring the inflammation down, including fish, foods containing vitamin D and fruits and vegetables.