Rheumatoid Arthritis

Over 1.3 million people in the US alone are affected by rheumatoid arthritis (RA), making this disease one of the leading causes of chronic pain and disability in the country. Being diagnosed with RA can have a wide range of profound consequences on a person’s life. Up to 30% of patients become permanently work-disabled within the first two to three years of the disease, while 41% and 11% experience activity and social limitations, respectively.

For many, what is truly challenging about receiving a diagnosis of RA is the fact that this condition has no cure. This means that, often, the only treatment options are pharmaceuticals, complementary therapies, and, eventually, surgery. It isn’t surprising that up to 48% of people with RA suffer from some form of depression.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a type of inflammatory arthritis, an autoimmune disease that occurs when the body’s immune system mistakenly attacks healthy tissues. This lifelong condition causes pain and stiffness in several joints across the body and, if left untreated, it can lead to permanent joint damage and disability.

To better understand what RA is and how it develops, let’s start by looking at how healthy joints work.

A joint is where two or more bones meet. Its role is to enable movement while controlling how far and in what directions the different bones and muscles move.

Thanks to the complex structure of connective tissues (i.e., tendons and ligaments) and cartilage, the joints across the body are able to prevent injuries – such as bones slipping out of place – and allow for everyday activities from walking and running to grasping objects and performing sports.

There are different types of joints in the body, but the most common one is a synovial joint. Synovial joints include the knee, hip, and shoulders, and are characterized by certain features:

• Strong bands of connective tissues – the ligaments and tendons – connect the bones and to the surrounding muscles. Their role is to prevent injuries and regulate the joint’s range of movement.
• The end of each bone is cushioned by a slippery disc of gel-like fluid, known as articular cartilage, which allows the bones to glide easily across one another during movement.
• The joint is encapsulated in a thin lining of tissue called synovium. This membrane produces hyaluronic acid and other substances that help keep the joint lubricated and protected from shock.
• Synovial tissue, called tenosynovium, lines the tight tunnels where the tendons run, to protect them from friction damage and allow them to glide within the tunnels.

Rheumatoid arthritis occurs when certain cells of the immune system begin to mistakenly attack healthy tissues in the body, especially the synovial tissue and the tenosynovium.

The malfunctioning immune cells begin to release substances that cause inflammation in the synovium, which causes it to swell and thicken. The inflammatory cells also begin to spread across surrounding tissues, including the cartilage and bones. When the tenosynovium is affected, the tendon sheaths (which are the tunnels that house the tendons) become swollen and cause damage to the tendons, leading to severe tendon tears.

Besides pain, stiffness, and reduced range of motion, if left untreated, RA can also lead to permanent joint damage and serious disability. However, thanks to advanced treatment options, it is now possible to modify the disease, prevent the progression of joint damage, and avoid the most serious complications of RA, including deformities and joint destruction.

Possible Complications of RA When Left Untreated

As we have seen, the latest advancements in research are helping patients avoid the most severe complications of RA and prevent disease progression. Nonetheless, if left unaddressed, the uncontrolled inflammation that fuels rheumatoid arthritis can lead to a range of severe complications.

Below, we’ll look at the most common conditions that occur when RA—and its underlying systemic inflammation—are left untreated.

Osteoporosis

Osteoporosis is characterized by the loss of bone mass and mineral density, leading to fragile, porous bones. This brittleness results from an imbalance in the body’s mechanism of forming new bone and reabsorbing old bone: in people with osteoporosis, bone mass is lost faster than it is regenerated.

Common risk factors for osteoporosis include age, family history, menopause, low body weight, and lifestyle habits like smoking and alcohol use. Because of these risk factors, the demographics at risk include postmenopausal women and those with a family history of osteoporosis.

Osteoporosis is considered an “invisible” illness—you may not notice you have it until a fracture occurs or you undergo a screening test. The most common bones fractured by people with osteoporosis include the hip, wrist, or spinal bones (vertebrae).

Osteoporosis differs from arthritis, but the two conditions may be interrelated. RA, especially if untreated, causes increased bone loss and higher osteoporosis risks. This occurs because the inflammatory process enhances bone erosion and causes large cysts around the joints.

Both factors contribute to a decline in the mineral content of the bone. Studies show that nearly 30% of people with RA have low bone mass density (osteopenia) or osteoporosis.

Rheumatoid Nodules

Rheumatoid nodules are firm lumps that often form under the skin near joints affected by RA. They can range in size—from pea-sized to golf ball-sized—and typically aren’t painful unless they enlarge and press on nearby nerves.

Given that they are a consequence of high levels of uncontrolled inflammation, the emergence of rheumatoid nodules aligns with the progression of the disease. They are more likely in people with high levels of rheumatoid factor or who have had the disease longer. Smoking and certain RA medications, like methotrexate and anti-TNF medications, can also increase the risk of rheumatoid nodules.

The most common joints affected by rheumatoid nodules include the elbows, fingers, and knuckles, but they can appear on or around any joint affected by RA. This complication can be effectively managed—and, in some cases, prevented—through timely diagnosis and appropriate treatment. Historically, around 30% of people with RA developed this complication; however, the incidence of rheumatoid nodules has decreased over time.

Sjogren’s Syndrome

Sjogren’s syndrome is an autoimmune disorder characterized by the immune system attacking the glands that produce moisture, primarily targeting those in the eyes and mouth. While the exact cause of this condition is debated, research shows that contributing factors may include environmental and genetic triggers.

There are some risk factors associated with a higher chance of developing Sjogren’s syndrome. These include being female and being aged 40 and over. Symptoms vary widely but usually include dry eyes and mouth, joint pain, and fatigue.

People with rheumatoid arthritis are at a significantly higher risk of developing this condition. It is estimated that up to 31% of people with RA show signs of Sjogren’s syndrome. This is because the immune system dysfunction in RA paves the way for other autoimmune disorders, including Sjogren’s syndrome.

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a painful condition of the hand and fingers due to compression of the median nerve as it traverses the carpal tunnel—a passageway in the wrist formed by the carpal bones and ligaments.

This nerve provides sensation to your thumb and most fingers, excluding the little finger. As the carpal tunnel narrows, the median nerve can become entrapped, inflamed, or compressed, interfering with normal nerve signals relating to sensation and movement. This can lead to problems with hand movement, pain, numbness, and tingling sensations.

The causes of CTS vary, often developing due to factors that increase pressure on the median nerve and tendons in the carpal tunnel. Risk factors include obesity, repetitive hand use, pregnancy, and conditions like diabetes or RA.

RA can increase the risk of CTS by causing inflammation of the synovium (the lining of the joint) and the tenosynovium (the lining of the tendons). Inflammation leads to fluid build-up and swelling, narrowing the carpal tunnel and causing CTS. It is estimated that up to a third of patients with RA will develop CTS.

Heart Problems

Heart problems, known as cardiovascular disease, refer to conditions that affect the heart and blood vessels, like coronary artery disease, heart attack, heart failure, and stroke.

These conditions stem from factors like poor diet, high blood pressure, elevated cholesterol, smoking, genetics, diabetes, and lack of physical activity. Often, systemic inflammation is a universal cause of heart problems.

Symptoms of heart problems vary, depending on the condition. Commonly, you may experience chest pain, shortness of breath, lightheadedness, fainting, and pain in the chest and upper body. Since certain heart problems can be fatal, early detection and treatment are essential to prevent life-threatening complications.

RA can be a risk factor for cardiovascular disease because chronic inflammation in RA can damage the heart muscle, blood vessels, and surrounding areas.

Uncontrolled inflammation can lead to atherosclerosis, causing the arteries to harden and narrow, increasing the risk of heart disease. It is estimated that people with RA have a 50-70% higher risk of heart problems compared to the general population.

Lung Disease

Lung disease describes any disorder involving dysfunction of the lungs or other parts of the respiratory system, causing chronic conditions like asthma and COPD to cancers and acute infections such as pneumonia.

Common causes of lung disease include smoking, exposure to pollutants and chemicals (e.g., asbestos), genetic factors, a compromised immune system, and certain infections.

RA may also contribute to lung disease due to chronic inflammation spreading to the lungs, causing scarring, which may lead to rheumatoid lung disease.

This complication is present in nearly 5% of older patients with RA, causing shortness of breath, persistent coughing, chest pain, fatigue, unexplained weight loss, and changes in voice tone.

Lymphoma

Lymphoma is a type of cancer that originates in the lymphatic system, which is involved in maintaining fluid levels in the body and combating infections. While the root cause of lymphoma is unknown, certain risk factors have been identified.

These include age (especially in adults over 55), a weakened immune system, exposure to certain chemicals, and certain infections caused by viruses or bacteria. If left unaddressed, lymphoma can cause life-threatening tumors in the lymph nodes.

Research shows that people with RA have a two-fold increased risk of developing lymphoma. This is because high levels of uncontrolled inflammation can lead to cell damage, the root cause of lymphoma.

How Is RA Diagnosed?

There is no specific diagnostic test to definitively prove you have RA. What’s more, the early symptoms of RA overlap with those of other conditions, often leading to patients waiting nearly 17 months before initiating treatment.

Nonetheless, your doctor may use a range of examinations and laboratory tests to determine the source of your pain. If RA is suspected, you may be referred to a rheumatologist to confirm the diagnosis. Below, we’ll look at the most commonly used tests in more detail.

• Medical History

Since RA symptoms develop over time, it can be hard to confirm a diagnosis when the disease is in its early stages. However, your doctor may suspect RA if you have a family history of RA or other autoimmune diseases.

A healthcare provider will also review influencing aspects, such as your general health, medications you take, and symptoms.

• Physical Examination

After reviewing your medical history, a doctor will carry out a physical examination. This exam isn’t painful but involves palpation of areas that may be painful. The medical team will look for signs of inflamed tendon sheaths, tender joints, limited range of motion, and early deformity. If symptoms are severe, they may also check for tendon tears and ruptures.

Since RA can develop across multiple joints, it is important to inform your doctor about all symptoms, even if they seem unrelated.

• Laboratory Tests

Although it isn’t possible to diagnose RA using a single test, the following examinations can be extremely helpful when analyzed together. These tests include:

Rheumatoid factor (RF): The RF test detects the presence of RF, a protein produced by your immune system. It is estimated that 60-80% of people with RA have RF. However, it is possible to have RA even if you test negative for RF (seronegative rheumatoid arthritis). Only 40% of those with early RA test positive for rheumatoid factor.

Anti-cyclic citrullinated peptide antibody (anti-CCP): The anti-CCP test confirms RA presence after an RF test. It detects anti-CCP antibodies, a protein often present in people with RA. This test is more accurate than the RF test, and people who test positive are very likely to get RA.

Complete blood count (CBC): CBC examines blood components like red blood cells, white blood cells, and platelets. Detecting abnormalities can provide insight into inflammation or iron deficiency (anemia), common indicators of RA.

Erythrocyte sedimentation rate (ESR): The ESR or Sed rate measures the rate at which red blood cells settle at the bottom of a test tube in one hour. If the cells sink faster than normal, this indicates higher-than-normal levels of inflammation. This test can also monitor how inflammation levels change over time.

C-reactive protein (CRP): CRP is produced by the liver in response to inflammation. Elevated CRP levels indicate high inflammation, typical in RA. CRP levels are also used to assess the extent of inflammation and monitor the effectiveness of RA treatments.

• Imaging Tests

Imaging tests provide a clear picture of the inner aspects of your joints, allowing your doctor to determine the presence of inflammation, abnormalities, and, in the case of RA, the extent of damage. Different tests can examine different types of tissues. These include:

X-ray: By emitting a concentrated beam of radiation toward the joints, an X-ray provides detailed images of dense structures like bone. These images help spot physical alterations or damage in your joints, such as bone erosions or narrowing of joint space. Although not present in the early stages of RA, X-rays may still be used to rule out other conditions.

Computed tomography scan (CT scan): A CT scan creates multiple images from different angles, producing a detailed cross-sectional view. It can reveal bone damage details that might not be clear in standard X-rays.

Magnetic resonance imaging (MRI): MRI captures high-resolution images of your joints using strong magnetic fields and radio waves. It reveals the presence of inflammation and early joint damage, tracking disease progression—something that may not be visible through other scans.

Positron emission tomography (PET scan): A PET scan detects radioactive material injected into your body. This material, known as a radiotracer, releases positrons, which interact with electrons, producing gamma rays picked up by PET scanners. These tools examine how tissues and organs are functioning, precisely determining the extent and location of inflammation.

Dual-energy X-ray absorptiometry (DEXA): DEXA directs two X-ray beams of varying energies toward the patient’s bones. By analyzing different absorption rates, doctors can obtain precise information about bone density and abnormal changes.

These tests, alongside ultrasound scans and more specific laboratory tests, can be used as stand-alone diagnostic tools or in combination with other methods to determine the presence of RA.

Start Your Journey to Better RA Management Today