Rheumatoid Arthritis: Five Effects on Joints, Bones, and Quality of Life

Rheumatoid arthritis is an autoimmune disease in which the body’s immune system attacks itself, resulting in inflammation and pain in the joints (1). Current research suggests that rheumatoid arthritis arises due to an interaction between certain genes, environmental risk factors, and sometimes infectious agents like bacteria. However, more studies are needed in order to understand entirely what causes rheumatoid arthritis (2).

We do know for certain that arthritis is more likely to arise in women, in people who smoke, and in people whose families have a history of the condition (3). According to a 2018 study, rheumatoid arthritis affects 1% of the population (4).

If your joints feel painful and inflamed regularly, start by talking to a health care provider about your complete medical history and the symptoms you’ve noticed. Your doctor may ask questions like:

• Do you have a family history of rheumatoid arthritis?
• Do you smoke? 
• Have you been exposed to harmful agents like asbestos? 
• Have you suffered from fever, fatigue, or loss of appetite?
• Do your joints feel warm? If so, how often? For how long?
• Do your joints hurt? If so, how often? For how long?
• Do your joints feel inflamed?  If so, how often? For how long?
• Do your joints feel stiff?  If so, how often? For how long?
• Have you noticed any pain in your muscles?  If so, how often? For how long?

Blood Work

After discussing your personal and family medical history, symptoms, and perhaps conducting a physical exam, your physician may order blood work or imaging. Blood work helps assess the concentration of certain proteins and inflammation markers, specifically the concentration of C-reactive proteins (5). High concentrations of C-reactive proteins, anti-cyclic citrullinated peptide (anti-CCP) antibodies, and elevated erythrocyte sedimentation rates (sed rates) are all potentially signs of rheumatoid arthritis (6).

Imaging

Imaging like X-rays, CT scans, MRIs, ultrasounds, and radionuclide bone scans, can be effective in confirming or ruling out a diagnosis of rheumatoid arthritis. X-ray examinations can show the narrowing of uniform joint space, which could indicate rheumatoid arthritis. They can also give your health care provider the chance to see any bone mineralization, cysts near your affected joints, and joint malalignment that rheumatoid arthritis may be causing.

CT scans show bony erosions quite clearly and can also guide your doctor in a treatment plan. Due to their sensitivity to bony and soft tissue changes, MRIs can be quite helpful in identifying signs of rheumatoid arthritis. Ultrasound can detect soft tissue ganglion cysts that may result from rheumatoid arthritis, and radionuclide bone scans are sensitive to early signs of rheumatoid arthritis (7).

The first signs of rheumatoid arthritis are swollen joints and stiffness. Stiffness often appears first in the hands and wrists and is typically worse in the morning. Some patients report waking up in the mornings unable to move their hands or to push themselves up from lying down. Oftentimes, the small joints connecting the fingers to the hands, and the toes to the feet, become swollen first. Knee joints and ankle joints may also be heavily affected.

Persistence of the disease can result in several severe complications:‍

Erosion of Both Cartilage and Bone

As rheumatoid arthritis develops and progresses, erosion of the cartilage and bones may follow the inflammation of synovial joint fluid (an egg-like fluid found in the cavities of certain joints, produced by a structure called the synovium) (8). Bone erosion is most often discovered through imaging. Observing and documenting bone erosion is a critical part of responding to rheumatoid arthritis and developing a treatment plan, as bone erosions can predict the severity of a case of rheumatoid arthritis and its potential likelihood of leading to disability. This erosion caused by painful swelling may also result in joint deformity (9).

Some therapies for rheumatoid arthritis attempt to slow down structural damage, which is reflected in the pace of bone erosion. So images of bone erosion not only help diagnose rheumatoid arthritis, but also serve as a key factor in tracking the progression of the disease over time.

Progressive cartilage erosion is another hallmark of arthritis (10). Attention to cartilage damage in patients with rheumatoid arthritis is just as important as watching bone erosion, as both complications can significantly impact quality of life, disability, and may be useful in predicting the course of a patient’s rheumatoid arthritis (11).‍

Osteoporosis

‍Rheumatoid arthritis may cause osteoporosis, which is the reduction of bone density (12). Sometimes, rheumatoid arthritis and osteoporosis are linked because the medications assigned to treat rheumatoid arthritis can trigger bone loss. Rheumatoid arthritis may also cause pain so severe that those suffering from the disease become quite sedentary and inactive, which poses another osteoporosis risk.

Rheumatoid arthritis can also spread across the body and affect new joints all by itself. In addition to being at higher risk for rheumatoid arthritis, women are also at a higher risk for suffering from osteoporosis (13).

Bone mineral density tests help doctors identify the onset and progress of osteoporosis in patients with rheumatoid arthritis. Because many patients with rheumatoid arthritis are treated with glucocorticoid therapy, which can result in significant bone loss, bone density tests are often a regular part of many patients’ courses of treatment. At times, hormone therapy or other medications may need to be considered for treating osteoporosis.

Nutrition and exercise are key factors in preventing and treating osteoporosis in people with rheumatoid arthritis. Maintaining a diet rich in calcium and vitamin D can improve your bone health. Patients with rheumatoid arthritis who want to combat the onset of osteoporosis or minimize its current effects may want to take calcium and vitamin D supplements. Prioritizing dairy products, dark green, leafy vegetables, eggs, and fish will help patients reach the recommended levels of calcium and Vitamin D for combating osteoporosis. Smoking and alcohol can negatively affect bone health.

Weight-bearing and resistance exercises can improve bone strength. While patients with rheumatoid arthritis may struggle to be active during flare-ups, the smallest of exercises – like short walks – combined with adequate rest can promote strength, balance, flexibility, and joint mobility.

Ongoing Pain and Fatigue

Certain measures indicate that, of all chronic diseases, rheumatoid arthritis has one of the most extreme effects on health-related quality of life. Continual pain and extreme fatigue are common consequences of rheumatoid arthritis (14). Some patients with rheumatoid arthritis suffer from difficulty sleeping because of joint damage, which further compounds fatigue (15). Patients may describe the fatigue related to rheumatoid arthritis as more than simply feeling tired or sleepy. Rather, they feel bogged down in their thoughts or actions.

The rheumatoid factor antibodies that cause pain for people with arthritis aren’t only found in the joints. They’re in the bloodstream as well, which may result in a sensation akin to fatigue that’s difficult to describe beyond a feeling that something just isn’t right in the body (16). Some rheumatoid arthritis patients may also have a mild form of anemia, which can lead to fatigue. The reduction in exercise and activity seen in many patients with rheumatoid arthritis could also contribute to their experiences of fatigue.‍

Inability to Work or Reduced Productivity at Work

Thirty percent of people with rheumatic disease say that their condition affects their ability to work (17). From 2008 to 2011, aggregate annual earnings losses for the approximately 900,000 people in the American workforce with rheumatoid arthritis came out to over $12 billion (18). Inability to work due to rheumatoid arthritis has also been linked to depression and an ongoing sense of frustration (19).

Because rheumatoid arthritis can affect daily activities like those required at work, many patients will need guidance from rheumatologists or therapists in how to manage pain throughout the day, as well as how to go about their daily activities in ways that minimize pain as much as possible. Exercises, alternating heat and cold, and moving in ways that cause the least amount of stress to the joints can all contribute to a patient’s ability to continue working.

Some patients with rheumatoid arthritis find support in occupational therapists who can teach them how to better manage stress, use self-help devices, and methodically talk through day-to-day activities so as to offer recommendations for reducing strain and conserving energy. They may also suggest devices that can protect the joints. Physical therapists can also be helpful to patients with rheumatoid arthritis who are struggling at work. They can suggest exercises for increasing muscle strength and decreasing joint stiffness. Physical therapists can also assist with heart health, weight management, and non-medicated pain control (20).

Increased Risk of Development of Additional Chronic Conditions

Rheumatoid arthritis raises the risk of developing cardiovascular disease, cancer, and respiratory disease (21). Specifically, rheumatoid arthritis is a risk factor for lung disease and conditions affecting lung tissue, such as pleurisy (which causes chest pain and shortness of breath), cancer, Hodgkin’s Lymphoma, and Non-Hodgkin’s Lymphoma (22). The risk of heart attack and stroke doubles for patients with rheumatoid arthritis (23).

Rheumatoid arthritis also leads to a higher risk of vasculitis, which is inflammation of the blood vessels, as well as carpal tunnel syndrome. It can also lead to pericarditis, which is the inflammation of the membrane surrounding the heart, and scleritis, which can negatively impact vision. Over time, rheumatoid arthritis may reduce the production of red blood cells in the bone marrow.

Nutrition, exercise, physical and occupational therapy, and weight management can all help patients with rheumatoid arthritis slow the progression of the condition and manage pain. First-line treatment options for rheumatoid arthritis include standard over-the-counter medications such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen and ibuprofen. If over-the-counter remedies don’t offer relief, stronger medications appropriate for rheumatoid arthritis include prescription-strength NSAIDs. In particular, topical diclofenac gel outperforms over-the-counter painkillers like acetaminophen for inflammatory pain.

Steroids and disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, adalimumab, leflunomide show therapeutic effects for pain resulting from rheumatoid arthritis (24). DMARD courses are especially helpful when started as soon as possible after the onset of rheumatoid arthritis, so don’t delay speaking to a doctor who specializes in rheumatology if you suspect you have the condition. Side effects of DMards include dermatitis, mouth sores, dry eyes, and kidney problems. Some patients also exhibit side effects of nausea, vomiting, and risks of secondary infections (25).

Other drugs recommended for rheumatoid arthritis include the anti-inflammatory drug sulfasalazine, the biopharmaceutical etanercept, the immunomodulator abatacept, and the immunosuppressants cyclosporine and hydroxychloroquine.

Rheumatoid arthritis affects the joints, bones, and muscles, which can make day-to-day activities uncomfortable and painful. Early treatment can be a key part of slowing the condition’s effects, so if you’re experiencing joint pain, stiffness, swelling, or redness, make an appointment with a healthcare provider. Simple tests, like blood work and imaging, may reveal the root of your pain or discomfort to your healthcare provider. If you’re diagnosed with rheumatoid arthritis, there are many options for condition management – ranging from lifestyle changes to prescription medications – that can help you manage your pain and go about your daily life as comfortably as possible.