EXPERT
It is so easy to forget that arthritis is not the only problem we see with rheumatoid arthritis, particularly when the disease is labeled and named an ARTHRITIS. However, the so-called extra-articular manifestations of rheumatoid arthritis can cause significant disability, even death.
It must not be forgotten that rheumatoid arthritis is a SYSTEMIC disease, the most basic manifestation being malaise and fatigue. But there can also be significant inflammation of a variety of organ systems, particularly in those patients who are rheumatoid factor positive. Such patients also, in general, suffer from more severe arthritis and often have nodules.
Rheumatoid nodules develop in about 50% of people suffering from rheumatoid arthritis, and most of these patients are rheumatoid factor positive. Another extra-articular manifestation of rheumatoid arthritis involving the skin is vasculitis.
Sjogren's syndrome can cause dry mouth and dry eyes, common in rheumatoid arthritis. Episcleritis is also common. Unfortunately, scleritis has a more damaging course, and can erode the affected part of the eye.
Many rheumatoid arthritis patients suffer from interstitial lung disease. But because patients are not that physically active due to their joint disease, they do not experience shortness of breath. Patients may also develop rheumatoid nodules in the lung tissue. Pleurisy, or inflammation of the lining of the lungs, may occur. Interestingly, methotrexate, a drug commonly used in rheumatoid arthritis, may itself cause interstitial lung disease, so it is best for patients to have a chest x-ray performed as a baseline before they are started on methotrexate.
Just as the lining of the lungs can be inflamed, that of the heart can also be inflamed, a condition called pericarditis. Rarely, there can be heart rhythm problems, heart valve malfunction and inflammation of the blood vessels, including the aorta.
There might be inflammation of the blood vessels supplying the intestines, resulting in abdominal pain.
Kidney disease is rarely seen in rheumatoid arthritis, but it can occur.
Neurologic damage can occur due to inflammation of the blood vessels supplying the nerves. It can also occur due instability of the cervical spine.
Blood changes can be seen also. Felty's syndrome has classically been described as rheumatoid arthritis, enlarged spleen, low white blood cell count, and leg ulcers. This is seen most commonly in patients with severe, nodule-forming rheumatoid arthritis.
Treatment of the non-joint manifestations of rheumatoid arthritis involves the same medications used to treat the arthritis.
Patients should not hesitate to let their doctors know if they have any other complaints outside the joints; it could be serious AND treatable.
oh great---more to worry about! I wish some of these doctors that write this stuff (although informative it is) put some of that energy into finding a cure or ways to help us better live with this disease.
It seems to me at least that doctors don't really seem at all that interested in RA and its slew of related diseases. And we have an incredible shortage of pediatric rheumatologists---there is only one in my state! My choice of where to bring my child is already made for me.
Sorry to be a little upset--yes its nice to read these great articles on what else we should watch for with this wonderful disease---but come on--how about some help and answers instead.
But thanks for this post--no offense to the poster---its just been one of those days. I am a volunteer board member for the Arthritis Foundation and I can't even get the docs themselves to come to our Arthritis Walk, speak at it, or donate. Docs lately have been very disappointing to say the least!Larry, Thank's for the information. RA has taken me by storm. I don't know if I have had problem's for a while and contributed it to the FM. Or if it all of a sudden started ro ravish me. I have had feels of aching around my rib cage. It almost feels like it is between the rib's. I don't know it just seem's as though it hit me very strong! I am still confused and trying to take in all the info. I can get. Thanx nut
An interesting article, Lev, thanks for posting it.
I've developed severe lung problems, for which I've been hospitalised 4 times in as many months. The dx is pneumonia, inc fluid, and the specialist is adamant the cause is RA, plus the use of MTX and/or Arava. His reasoning is that these anti-inflammatory drugs further suppress the immune system and in addition to the RA, leave the body with nothing to fight with. He's taken me off MTX and Arava and the big surprise is that while the RA gives a twinge now and then, it's not too bad.
Oh, what a serpertine disease - we all seem to have different experiences and benefit from different treatments. Thanks again for the article - cheers, Des.
Lev - As always, another interesting article. I really appreciate all the researching and info that you post. Having RA, I want to be as informed as I possibly can, be it good or bad, AP or traditional meds. In the end, we are all our own advocates.. in charge of our own health. We have choices and we need to be educated and informed in order to make the choices that we feel are right for us. Thank you for your help!
Lori
Wysone,
Many people and universities and companies are working very hard to find us relief and even a cure. I figure the cure or at the very least complete safe relief is only two ,three years maximum away. All we have to do is be aware of the things that we need to watch for to insure that we make it to the cure. You and us aren't just having a bad day, we're all in a war to save our bodies and our lives.
LEV
gosh--I hope a cure is only that far away--that would be great!! I am 38 years sick of this disease.
thanks for the postLev, as I wrote on another thread I have pulm, cardiac involvement and know how important it is to take care of your health. Your doctor may only diagnose RA but the longterm diagnosis may mean any of the aforementioned complications from RA and everyone needs to be aware of the symptoms of these diseases. LindyThanks for the heads up on this Lev, interesting article.
I keep telling my doctors that I feel as if my brain has been fried (nervous system) with the onset of RA.
They keep telling me it is all in the head, go see a head doctor.
Maybe RA or the drugs have upset things.
thank you for this article very interesting
have a nice evening
Another great article. Thanks for the information. Knowledge is power.
Now I'd like to ask those of you on MTX. Did your doctor order a baseline X-Ray before starting the MTX, as mentioned in the article? Mine didn't, but then again, he didn't order a baseline retina eye exam for the Plaquenil either. The eye doctor did.
My daughter had baselines before starting mtx, including a chest xray.Jesse, yes, I had baseline xrays of hands, feet, and lungs. LindyMine didn't do a baseline chest x-ray either. Since 2004, I've had very little x-rays actually. On my first visit in 2004, I had chest and feet x-rays. Last year, I had an x-ray of my left wrist. No yearly x-rays.OK, I know why my doctor didn't do one for hands, feet, etc. No sign of problems there. But it seems it's important to do a chest X-Ray before starting the MTX. Anyone else? haven't had any xrays at all...
My Rd did not do chest xray for Mtx but since they want to start me on remicade I will be getting one.I went to the appt. thinking I was going home with a mtx rx, since we had collected a second ped rheum opinion and also our AP drs. opinion it was necessary. My daughter had just started AP like two days before. But we didn't get the rx, just had the xrays done.
Six weeks later, the day before our next appt., I got a call to come in early. That chest xray, done SIX WEEKS ago, had an abnormality.
We arrived early, and were told they were re-doing the chest xray and we were seeing a pulmonologist. She had markings of interstitial lung disease.
Freakout! But nothing made sense. She never coughed, was never out of breath although she was very active....
When we met with the pulmonologists (always a group 'thang' where we go), they talked very seriously about the risk of mtx causing lung problems. But they said she could start mtx, because what was on the xray six weeks ago was gone. Just let them know if she ever ever ever coughed, etc. when she started mtx.
I said, hmmm, she started Zithromax six weeks ago....and the attending said, "Zithromax?" and stared at me like I had three heads. Then that awkward moment passed, and they said we could leave and I said, "I'm leaving again with no mtx????" and they said no, stay LOL.
So she started mtx and started coughing pretty much right away but nobody listened, give her the shot. Coughed for four weeks until she finally ran a temp (and I was still told to give her the shot) and then was dx'd with pneumonia.
Moral of the story: You cannot win. Xrays. No xrays. Doesn't matter.
Just a couple of responses from me to responses from a couple of yous. I agree with you all that this is a A plus article by the doctor.
Bodak, I think that the response from the Dr. about your mental concerns would have been better if he had explained the possible "normal" reasons for the mental changes. Gosh, When I first was dxed and then added the drugs that have a tendancy to scramble the brain and you know, this disease takes up a whole lot of brain space, whew, I was scrambled. Very seldom is this disease not on my mind. Gee whiz, I couldn't remember such simple things. I'm not sure I'm any better maybe just used to it. I guess if the doctor explained all the natural causes of our brain fog and bogg and smogg and memory loss and computer freeze with this disease and drugs and you were still concerned then by all means recomend mental health to help but I'm pretty sure that you are just using up so much computer space that you just aren't the same any more but hey, you are in a very big boat and all of us are aboard on the very same cruise, oh yeah, where we going again?
Jesse,
I wasn't given chest x-rays, everything else but not lungs even thugh I was a 3 pack a day smoker and breathed heavy. Mtx guidelines is for chest x-rays for someone like me prior to prescribing mtx. With-in three or four weeks, I stated coughing and then coughing up white, then green and then grey and then stated coughing and couldn't stop and by the time I went to urgent care I had lost 30% of my left lung. The hospital was very concerned that I was going to take legaL action against them but it was probably more my fault than theirs. From the time I was prescribed mtx the rheumies, my gm, the pharmd all warned me about any changes in lung or breating function and especially cough to go directly to urgent care and I kinda waited because prior to my body had always taken care of all of my health problems, I was smarter than my doctor, not anymore.
LEV
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