Rheumatoid Arthritis

When people think of rheumatoid arthritis (RA), theycount, diabetes, alcoholism, and organic brain
often picture somebody with a few aches andsyndromes, such as previous stroke or
pains… no big deal. If they have had a familyAlzheimer’s disease. The risk for infections
member affected or seen people with the disease,requiring hospitalization- serious infections- is also
they may also fear the crippling and deforming effectsincreased. These infections include, pneumonia, skin and
of the illness.soft tissue infections, sepsis (infection in the
The reality though, is RA is an extremely seriousbloodstream, infected joints, abdominal infections, and
condition that affects the entire body.osteomyelitis (bone infections).
Of grave concern are the mortality statisticsPredictors of high risk for infection in patients with RA
associated with the disease. Severe rheumatoidinclude: reduced functional capacity, an elevated
arthritis can shorten life expectancy by 10-15 years! Aerythrocyte sedimentation rate (ESR or “sed
study conducted by the Center for Disease Controlrate”), the presence of rheumatoid factor in the
and Prevention in Atlanta looking at data accumulatedblood, the presence of rheumatoid nodules or other
from 1965 to 1990 demonstrated that patients with RAnon-joint RA involvement.
have a mortality ratio of 2.26 compared to the generalMalignancies such as lymphoma are also increased in
population. That means they are more than twice asincidence in patients with severe RA. Low risk of
likely to die!lymphoma occurs with mild disease. However, as the
Rheumatoid arthritis is considered a systemicseverity of disease increases, the risk of acquiring
disease… one that affects many organlymphoma can increase to as high as 70 per cent in at
systems. For instance, inflammation of theleast one study looking at this complication.
cricoarytenoid joints- the vocal cords- is a commonThe eyes are not spared. Inflammatory disease of the
finding. And the lungs also may be affected early on.eye such as scleritis and episcleritis can be a significant
The initial manifestations may be subtle but as theproblem for RA patients. And Sjogren’s
disease progresses, the lungs can become sodisease, an autoimmune disease that affects the ability
diseased that the respiratory complications also lead toof the tear glands and saliva glands to produce
death.secretions, is another potential pitfall that can arise.
The heart is another target organ. When patients withRheumatoid nodules, which are large collections of
RA undergo an ultrasound study of the heart, almostinflamed tissue can develop at the elbows, hands, and
50 per cent of patients who have no symptoms willAchilles tendons. In patients with severe RA, vasculitis-
have abnormalities of the pericardium, the sack thatinflammation of blood vessels- can cause skin ulcers
encloses the heart.to occur.
Another disturbing finding is that the risk of dying fromThe blood is also affected. Many patients with
coronary artery disease is five times greater inrheumatoid arthritis develop the anemia of chronic
women with early-onset rheumatoid arthritis. Thedisease. This is a form of anemia that is brought about
incidence of angina is also markedly increasedby the chronic inflammation and is not responsive to
compared with people without RA. Point of fact:iron therapy. Low white blood cell counts, high white
cardiovascular causes are a primary cause of deathblood cell counts, and increased platelet counts can
with up to 42 per cent of rheumatoid arthritis deathsalso be seen.
arising from this factor.The upshot is that when patients have rheumatoid
An additional sobering statistic is that RA patients havearthritis, it’s “not just a few aches and
a 6-9 fold increase in risk of infection- related deaths.pains… nothing I can’t live
Predictors of risk for infections are increased age,with…” It is a serious, potentially
male gender, chronic ling disease, low white blood celllife-threatening condition.