World Autoimmune Arthritis Day is observed on May 20 every year to raise awareness about different types of autoimmune arthritis and spread awareness about them. Rheumatoid arthritis (RA) is a type of autoimmune arthritis wherein the body’s immune system attacks its own tissue including joints. The symptoms of arthritis are fever, swollen lymph nodes, loss of hand function, difficulty in mobility, sleep disturbances among others. Rheumatoid arthritis not just affects your joints, but also different aspects of health putting one at risk of cardiovascular issues, hypertension, fatty liver, lung disease and even cancer. (Also read: World Autoimmune Arthritis Day 2023: Date, history, significance and celebration)
Arthritis and its different types
“Arthritis is a condition characterized by joint inflammation, is a severe health issue that inflicts intense pain and stiffness on individuals. It encompasses a wide range of disorders that affect the joints, surrounding tissues, and connective tissues. There are over 160 different types of arthritis, which can be triggered by various factors such as medications, autoimmune responses, infections, trauma, crystals, or malignancies. The most common forms include osteoarthritis (OA) and rheumatoid arthritis (RA), with RA being an autoimmune disorder primarily affecting women aged 30 to 60. In India alone, approximately 1 in 100 individuals are affected by rheumatoid arthritis,” says Dr Preet Pal Thakur, Co-founder of Glamyo Health.
What is rheumatoid arthritis
Rheumatoid arthritis is an autoimmune and inflammatory disease in which a person’s immune system attacks its own healthy cells in the body leading to painful joints, swelling in the affected joints in the body which leads to restricted activities and joints deformities. It most commonly attacks joints in the hands, wrists, elbows, ankles etc. Due to chronic inflammation, the lining of the joints get inflamed, leading to damage to joint tissues. It will lead to long-lasting or chronic pain, restricted activity and joints deformity. If the disease is left untreated, it may also affect other tissues throughout the body leading to systemic complications like interstitial lung disease, bone marrow involvement, cardiovascular involvement leading to cardiomyopathy, and pericarditis, says Dr Santosh Kumar Agrawal, Sr. Consultant physician, Internal Medicine, Marengo Asia Hospitals Faridabad.
Many complications of rheumatoid arthritis
“Rheumatoid arthritis (RA) is not only a disease that affects the joints but also impacts various other aspects of a patient’s health. One significant concern is the increased risk of cardiovascular disease (CVD) in individuals with RA. Numerous studies have shown a higher prevalence of CVD in RA patients compared to the general population. The chronic inflammation characteristic of RA plays a crucial role in this heightened risk. It contributes to endothelial dysfunction, accelerates the development of atherosclerosis, and increases the likelihood of cardiovascular events such as heart attacks and strokes,” says Dr Sandeep Surendran, Consultant, Rheumatology and Clinical Immunology, Amrita Hospital, Kochi.
“Additionally, traditional risk factors for CVD, including hypertension, dyslipidaemia, obesity, and smoking, are often more prevalent in RA patients. To effectively address the increased risk of CVD in RA patients, it is crucial to prioritize early detection and aggressive management of these traditional risk factors. Proper control of RA inflammation is also paramount. This necessitates integrated care and collaboration between rheumatologists and cardiologists to ensure comprehensive management and improved outcomes for RA patients,” adds Dr Sandeep.
Deadly diseases that can be caused by rheumatoid arthritis
Dr Sandeep shares diseases people with rheumatoid arthritis are at risk of:
1. Osteoarthritis and knee replacement in rheumatoid arthritis
RA heightens the risk of osteoarthritis and the need for knee replacement surgery. The chronic inflammation in RA leads to joint damage and cartilage loss, making individuals more susceptible to secondary osteoarthritis. Studies have revealed a higher prevalence of knee osteoarthritis in RA patients compared to the general population. The aggressive nature of RA can further exacerbate joint destruction, ultimately necessitating knee replacement surgery. However, early and effective management of RA is key in controlling inflammation and reducing the risk of secondary osteoarthritis, potentially mitigating the need for knee replacement.
2. Fatty liver disease
In addition to joint-related complications, RA has been associated with an increased risk of fatty liver disease. Chronic inflammation in RA can cause metabolic abnormalities, including insulin resistance and dyslipidaemia, which contribute to the development of non-alcoholic fatty liver disease (NAFLD). Studies have demonstrated a higher prevalence of NAFLD in RA patients compared to the general population. Furthermore, certain medications commonly used to manage RA, such as corticosteroids and methotrexate, can further elevate the risk of fatty liver. Regular monitoring of liver function and adopting lifestyle modifications, such as weight management and healthy dietary habits, are crucial in minimizing the risk and progression of fatty liver disease among RA patients.
Another concerning aspect of RA is its association with an increased risk of certain types of cancer. Chronic inflammation linked to RA can contribute to the development and progression of cancer. Studies have indicated a higher risk of lymphoma, particularly non-Hodgkin’s lymphoma, in individuals with RA. Additionally, RA patients may be more prone to lung, skin, and gastrointestinal cancers. The use of immunosuppressive medications, including methotrexate and biologic agents commonly prescribed for RA, may also contribute to the overall cancer risk. To mitigate this risk, regular cancer screening, vigilant monitoring, and appropriate management of RA inflammation are vital for early identification and treatment of potential malignancies in RA patients.
RA patients also face an increased risk of stroke. The chronic inflammation characteristic of RA can lead to vascular dysfunction, accelerate the progression of atherosclerosis, and heighten the likelihood of cardiovascular events, including stroke. To reduce the incidence of stroke in RA patients, it is essential to control RA inflammation effectively. Additionally, managing traditional stroke risk factors, such as hypertension, dyslipidaemia, diabetes, and smoking cessation, is crucial in minimizing the overall risk.
Dr Akhilesh Yadav, Associate Director – Orthopaedics & Joint Replacement, Max Hospital Vaishali adds more diseases to the list.
5. Cardiovascular Disease
People with RA have a higher risk of developing cardiovascular disease (CVD). In India, CVD is the leading cause of death. The inflammation caused by rheumatoid arthritis can damage the blood vessels and lead to the development of CVD. People with rheumatoid arthritis should monitor their blood pressure, cholesterol levels, and blood sugar levels to reduce their risk of developing cardiovascular disease.
People with rheumatoid arthritis have a weakened immune system, which makes them more susceptible to certain infections. In India, infectious diseases such as tuberculosis (TB) and hepatitis B and C are prevalent. People with rheumatoid arthritis should take steps to prevent infections by practicing good hygiene and getting vaccinated against infectious diseases.
Dr. Santosh Kumar Agrawal, Sr. Consultant physician, Internal Medicine, Marengo Asia Hospitals Faridabad shares more diseases that can be caused by rheumatoid arthritis.
7. Felty’s syndrome
It’s an unusual complication occurring due to rheumatoid arthritis. This happens when your spleen is enlarged and your white blood cell count goes low. It may increase the risk of lymphoma.
8. Lung Problems
Your lungs may get inflamed owing to rheumatoid arthritis. It may result in pleuritis (pleurisy), a condition that makes breathing painful. Rheumatoid nodules may develop in your lungs too, leading to issues like a collapsed lung, coughing up blood, infection, or pleural effusion, which is fluid accumulation between the lining of your lung and your chest cavity. Due to rheumatoid arthritis, Interstitial lung diseases may develop. These lung diseases lead to scarring of the lung tissues and pulmonary hypertension, a type of high blood pressure that severely harms arteries in the lung and heart.