Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation, typically leading to pain, stiffness, and swelling in the joints. Because RA is systemic, the immune system’s attack can affect tissues and organs throughout the body, leading to manifestations outside of the joints. These less common symptoms can involve the skin, nerves, internal organs, eyes, and blood, often signaling more severe disease activity. Understanding these varied symptoms is important for managing the overall health of someone living with RA.
Skin and Nerve Manifestations
The skin and peripheral nerves are frequently affected by chronic inflammation associated with rheumatoid arthritis. One recognizable non-joint feature is the development of rheumatoid nodules. These are firm, painless lumps that form just beneath the skin, typically appearing near pressure points like the elbows, knuckles, and heels. They are essentially local sites of inflammation, and their presence is often linked to more severe or long-standing disease.
A more serious skin-related issue is rheumatoid vasculitis, a rare complication involving inflammation of the small and medium-sized blood vessels. This condition can lead to rashes, painful skin ulcers, or small pits around the fingernails, as restricted blood flow damages the skin tissue. When vessels supplying the nerves are affected, it can cause peripheral neuropathy. This results in numbness, tingling, or a burning sensation, especially in the hands and feet, and can contribute to muscle weakness.
Impact on Major Internal Organs
The systemic nature of rheumatoid arthritis impacts major internal organs, especially the heart and lungs. Chronic inflammation significantly increases the risk of cardiovascular disease by accelerating atherosclerosis, or the hardening of the arteries. This accelerated risk means that people with RA face a higher likelihood of experiencing a heart attack or stroke compared to the general population. Inflammation can also directly affect the heart, leading to conditions like pericarditis, which is the swelling of the sac surrounding the heart.
The lungs are a common target for extra-articular RA, and pulmonary involvement is a frequent non-joint complication. Interstitial Lung Disease (ILD) is a concerning manifestation where inflammation causes scarring, known as fibrosis, in the lung tissue. This progressive scarring leads to symptoms like persistent cough and shortness of breath, especially during physical activity. Inflammation of the lung lining, called pleuritis, can also occur, sometimes causing fluid to build up around the lungs.
Ocular and Hematological Effects
The inflammatory processes in rheumatoid arthritis can extend to the eyes and affect the blood. A frequent eye-related complaint is severe dryness, known as keratoconjunctivitis sicca, often occurring as part of secondary Sjögren’s Syndrome. This dryness results from inflammation damaging the tear glands, leading to discomfort, a gritty sensation, and sometimes blurred vision. A more severe complication is scleritis, which is a deep, painful inflammation of the white outer layer of the eyeball.
Chronic systemic inflammation can disrupt the normal production and lifespan of blood cells. Many people with RA develop anemia of chronic disease, where persistent inflammation suppresses the bone marrow’s ability to produce new red blood cells. This contributes to generalized fatigue and paleness, distinct from the fatigue caused by active joint disease. In rare instances, patients with long-standing RA may develop Felty Syndrome. This triad is characterized by RA, an enlarged spleen, and neutropenia (a low white blood cell count), which significantly increases the risk of serious bacterial infections.