Symptoms and Complications of Rheumatoid Arthritis (RA)

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
—Bone Density
—Swan Neck Deformity


Abstract painting of mist in the catskills by Janet PaulmennAlthough rheumatoid arthritis is often thought of as a disease that affects only the joints, it is actually a systemic disease, which means that it can affect nearly any part of the body.

Common symptoms include fatigue, weakness, muscle pain, reduced appetitie as well as heart, kidney, lung, and vascular problems.

Symptoms of Rheumatoid Arthritis. The disease usually begins gradually with fatigue, morning stiffness (lasting more than one hour), widespread muscle aches, loss of appetite, and weakness. Eventually, joint pain appears. When the joint is not used for a while, it can become warm, tender, stiff, and swollen. Joint pain is often felt on both sides of the body, and may effect the wrist, knees, elbows, fingers, toes, ankle or neck. Medline Plus.

Are foot and ankle characteristics associated with falls in people with rheumatoid arthritis (RA)? A prospective study. Foot and ankle characteristics are not associated with falls in people with RA and enquiries about prior falls and psychotropic medications may assist in identifying patients with RA who are at high risk of future falls. PubMed, Arthritis Care Res (Hoboken), 10/21/2016.

Is articular pain in rheumatoid arthritis (RA) correlated with ultrasound power Doppler (PD) findings? Intra-articular PD was not correlated with pain symptoms patients with RA. PubMed, Clin Rheumatol, 05/09/2015.

Depression and pain in patients with rheumatoid arthritis (RA): Mediating role of illness perception. Targeting illness perceptions in adults with RA and depression may help reduce pain symptoms. ScienceDirect, The Egyptian Rheumatologist, April 2014. (Also see Depression)

Cardiac Involvement

Heart Disease and Rheumatoid Arthritis. Rheumatoid arthritis almost doubles the risk of having a heart attack within the first 10 years of getting an RA diagnosis. WebMD.

Impact of disease activity and treatment of comorbidities on the risk of myocardial infarction (MI) in rheumatoid arthritis. C–reactive protein (CRP) was associated with risk of MI and the results underline the importance of tight disease control taking not only global disease activity, but also CRP as an individual marker into account. Bio Med Central, Arthritis Research & Therapy, 08/05/2016. (Also see DMARDs)

Clinical profile and outcome of patients with rheumatoid arthritis (RA) and abnormally high aortic stiffness (AoSI). Increased AoSI is common, can be predicted by an ordinary clinical assessment and is a strong predictor of adverse clinical outcome at mid–term follow–up in patients with RA. Sage Journals, European Journal of Preventive Cardiology, 05/10/2016.

Cardiovascular (CV) risk in rheumatoid arthritis (RA): assessment, management and next steps. Tight control of disease activity, management of traditional risk factors and lifestyle modification represent, amongst others, the most important steps in improving CV disease outcomes in RA patients. Sage Journals, Therapeutic Advances in Musculoskeletal Disease, 05/10/2016.

Arterial stiffness (AS) is associated with left ventricular (LV) dysfunction in patients with rheumatoid arthritis (RA). The aim of the study was to evaluate the impact of AS on LV functions in patients with rheumatoid arthritis. Springer Link, 01/07/2016.

Coronary(CAC) and Abdominal Aorta Calcification (AAC) in Rheumatoid Arthritis (RA): Relationships with Traditional Cardiovascular Risk Factors, Disease Characteristics, and Concomitant Treatments. In patients with RA, CAC and AAC are more prevalent and more severe compared with age–matched and sex–matched control participants. Current use of methotrexate is a major determinant of the absence of CAC, and erosive arthritis is a major determinant of AAC. PubMed, J Rheumatol, 2014 Oct 1.

Lipid and lipoprotein levels and trends in rheumatoid arthritis (RA) compared to the general population. RA patients appear to have an overall lower total cholesterol and low density lipoprotein than the general population, despite the general overall risk of cardiovascular disease in RA from observational studies. PubMed, Arthritis Care Res, 2013 Aug 7.

Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease. RA patients without coronary artery disease have higher prevalence, extent, and severity of all types of coronary plaque. PubMed, Ann Rheum Dis, 2013 Jul 25.

Eye Involvement

Can rheumatoid arthritis affect the eyes? Eye conditions associated with rheumatoid arthritis may include dry eyes, uveitis, scleritis, glaucoma and cataracts. Mayo Clinic.


Association Between Fatigue and Pain in Rheumatoid Arthritis: Does Pain Precede Fatigue or Does Fatigue Precede Pain? In established RA, pain and fatigue show monthly fluctuations that are synchronous; the results do not indicate that one precedes the other. Arthritis Care & Research Volume 65, Issue 6, pages 862–869, June 2013.


Bone Density

There is still a care gap in osteoporosis management for patients with rheumatoid arthritis. Although compliance with current osteoporosis guidelines remains low among all patients with rheumatoid arthritis, higher risk patients were more likely to have a bone mineral density test and receive treatment for osteoporosis. PubMed, Joint Bone Spine, 2014 Apr 2. (Also see Osteoporosis)

Swan Neck Deformity

Drawing of Swan Neck Deformity. Netter Images.

Swan-neck deformity is a bending in (flexion) of the base of the finger, a straightening out (extension) of the middle joint, and a bending in (flexion) of the outermost joint. Merck Manuals.

Structural deterioration of finger joints with ultrasonographic synovitis in rheumatoid arthritis patients with clinical low disease activity (CLDA). Even in patients with a long period of CLDA, finger joints with positive synovial vascularity showed structural alteration, especially in the progression of joint space narrowing. PubMed, Rheumatology (Oxford), 2014 Apr 4.


Neuropathy Causes And Treatments. Autoimmune diseases such as lupus and rheumatoid arthritis also increase one's chance of developing a neuropathy. Medical News Today. 02/20/2012.

Psychological Factors

Immune responses to stress in rheumatoid arthritis (RA) and psoriasis. Patients with RA have a different immune response to stress than patients with psoriasis or healthy controls. More needs to be learned about the complex interaction between stress, immune parameters and chronic inflammation. PubMed, Rheumatology (Oxford), 2014 May 20. (Also see Psoriasis, and Stress)

Impact of psychological factors on subjective disease activity assessments in patients with severe rheumatoid arthritis (RA). One of the subjective components of the DAS28, patient VAS, was highly correlated with cognitive factors and depression in those with severe RA. Wiley Online Library, 12/13/2013.

Pulmonary (Lung) Involvement

Functional Impact of a Spectrum of Interstitial Lung Abnormalities (ILAs) in Rheumatoid Arthritis (RA). Improved risk stratification and detection of ILAs will provide a therapeutic window that could improve RA-ILD (interstitial lung disease) outcomes. CHEST Journal 2014;146(1):41-50.

Lung involvement in connective tissue diseases (CTD): A comprehensive review and a focus on rheumatoid arthritis. Rheumatoid Arthritis (RA), unlike other rheumatic disorders, resembles Idiopathic Pulmonary Fibrosis (IPF) in numerous aspects. PubMed, Autoimmun Rev, 2013 May 15. (Also see Correlation of Pulmonary Fibrosis and Connective Tissue Disease)

Renal (Kidney) Involvement

End Stage Renal Disease (ESRD) in Patients with Rheumatoid Arthritis. Physicians should be aware of the critical impact of the comorbidities of diabetes and hypertension in causing ESRD in RA patients. Seminars in Arthritis and Rheumatism, 07/16/2016.

Vigilance for Kidney Problems Key for Rheumatoid Arthritis Patients. RA patients should have periodic testing for kidney problems, and should keep blood pressure under control, avoid a high–salt diet, and cut back medications that are damaging to the kidneys. Mayo Clinic, 04/11/2014.

Swan Neck Deformity

Swan Neck Deformity is a classic feature of rheumatoid arthritis that is related to laxity and instability of the joint as the rheumatoid lesion destroys the supporting tissues. It is almost never seen in systemic scleroderma (SSc) unless it is in overlap with rheumatoid arthritis (RA).

Vascular Involvement

Vascular calcifications on hand radiographs in rheumatoid arthritis (RA) and associations with autoantibodies, cardiovascular risk factors and mortality. Vascular calcifications on hand radiographs were independently associated with increased all-cause mortality in RA. PubMed, Rheumatology (Oxford), 04/07/2015.

Rheumatoid vasculitis: an update. Rheumatoid vasculitis remains a rare yet challenging extra-articular manifestation of rheumatoid arthritis with high morbidity and mortality, despite aggressive use of disease-modifying therapy. PubMed, Curr Opin Rheumatol, 2015 Jan;27(1):63-70.

Endothelial Dysfunction in Rheumatoid Arthritis. Patients with rheumatoid arthritis are prone to atherosclerosis. Increased MCPIP is found in rheumatoid arthritis leading to endothelial dysfunction. ATVBAHA, April 11, 2013.

Complications Due to Rheumatoid Arthritis

Occasional presence of herpes viruses in synovial fluid and blood from patients with rheumatoid arthritis and axial spondyloarthritis. Results indicate the occasional presence of DNA from herpes viruses in patients with rheumatoid arthritis or with axial spondyloarthritis. PubMed, Clinical Rheumatology, 05/20/2015. (Also see Ankylosing Spondylitis)

Sleep Problems in Patients with Rheumatoid Arthritis (RA). Poor control of RA is associated with a reduction in sleep quality and decreased daytime sleepiness, which is likely explained by pain-related alertness. PubMed, J Rheumatol, 2013 Dec 1. (Also see Sleep Disorders and Illness)

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