Rheumatoid arthritis, which affects up to 3 times as many women as men, can also cause nonjoint-specific symptoms, including fever, weight loss, and fatigue.

Left untreated, RA can lead to a number of complications or comorbidities (co-occurring conditions) throughout the body.

These complications and conditions may be more fatal to people with RA than those without. In fact, people with RA are nearly twice as likely to succumb to health problems like cancer and heart and respiratory conditions before age 75 than those without the disease, according to a 2018 study.

Rheumatoid Arthritis and Heart Disease Risk

People with RA often suffer from one or more additional conditions. Some of these comorbid conditions may be unrelated to RA, like certain cancers, but in other cases they may be directly or indirectly caused by RA, RA treatment, or RA outcomes — such as decreased mobility and functional impairment, for example.

The most common and well-documented RA comorbidity is cardiovascular disease, in particular ischemic heart disease, in which there’s a reduced blood supply in the heart. People with heart disease are about twice as likely to also have RA compared with those who don’t have heart issues.

Rheumatoid arthritis is also associated with several specific cardiovascular issues, including heart attack, stroke, congestive heart failure, peripheral vascular disease, and atrial fibrillation.

Research from 2015 found that people with RA are more likely to have atherosclerosis (buildup of fat, cholesterol, and plaque on blood vessel walls), and they develop it at a faster rate than the general population.

People with preclinical RA (a precursor condition to RA) aren’t safe from heart issues either. One study found that people with preclinical RA have a 24 percent increased risk of having a cardiovascular event over a 10-year period.

What’s more, people with RA experience more severe acute coronary syndrome (ACS) — heart attack, unstable angina, and other symptoms associated with sudden reduced blood flow to the heart — compared to the general population. A cohort study published in 2018 found that people with RA have 1.3 times the risk of heart failure compared with people without the disease.

The increased risk for ACS begins early in RA, too. A study from 2017 found that people newly diagnosed with RA have an approximately 40 percent increased risk of ACS compared with the general population.

And those RA patients who do survive ACS have a 30 percent increased risk of ACS recurrence and increased risk of death compared with the general population, according to a 2017 study.

But treatment with RA medications called disease-modifying antirheumatic drugs (DMARDs) may improve the early stages of heart disease, according to a 2020 study.

For these reasons, it is important for people with RA to assess their cardiovascular disease risk factors, such as high blood pressure, diabetes, and smoking, and take steps to address them.

Other Health Conditions Related to Rheumatoid Arthritis

People with RA have an increased risk of infections that may be related to the immune system dysfunction associated with RA

or to certain drugs that are used to treat the condition.

These drugs include corticosteroids, which reduce immune system activity and are the strongest contributors to serious infections in RA patients. Researchers reported in 2019 that people with RA had a 70 percent increased risk of serious infections compared with those with non-inflammatory rheumatic and musculoskeletal diseases — but that increased risk drops to 30 percent after controlling for corticosteroid use.

Infections account for about one-quarter of all RA-related deaths.

On the flip side, research from 2015 suggested that recent gastrointestinal and urinary tract infections may reduce a person’s risk of developing RA by altering the microbiome (the microbial community of the body).

Malignancies associated with the lymphatic system, such as lymphoma, are also a risk for people with RA.

Additionally, RA affects the lungs and can cause RA-related lung disease. It’s estimated that 1 in 10 people with RA will develop interstitial lung disease.

This disease accounts for 10 to 20 percent of all RA deaths.

Research from 2018 also found that people with asthma have 1.7 times the odds of people without asthma to have RA.

Rheumatoid Arthritis Complications

Complications are health issues that are caused by a condition or its treatment. The risk of complications from RA increases over time or when treatment is inadequate.

Over time, RA can cause more than just pain and inflammation in the joints — it can actually deform joints, making it difficult for people to perform normal daily activities.

RA can cause inflammation to develop in other areas of the body, including:

Blood vessels, where it’s called rheumatoid vasculitis and can cause problems with the skin, nerves, heart, and brain
Lungs, resulting in rheumatoid lung disease or other conditions, such as pleurisy (swelling and scarring of lung tissue) or pulmonary nodules
Eyes, causing Sjögren’s syndrome, which interferes with tears and saliva production; and scleritis, which is marked by eye redness and pain
Heart, particularly the outer lining of the heart (pericarditis) and heart muscle (myocarditis)
Wrists, causing carpal tunnel syndrome, in which pressure on the nerves of the hand results in numbness, tingling, and difficulty using the hands and fingers

Numerous other complications are also possible, including:

Peripheral neuropathy, a dysfunction of nerves that results in nerve pain, numbness, and tingling, particularly in the hands and feet
Muscle weakness
Anemia, a decreased red blood cell count that increases fatigue and weakness
Various skin conditions, such as blisters, rashes, ulcers, lumps under the skin
Osteoporosis, or low bone density
Spinal injuries (when neck bones are damaged from inflammation)
Periodontal (gum) disease, though some research suggests this disease precedes RA, and other research suggests some cases of RA may be caused by the same bacteria behind gum disease.
Kidney impairment caused by RA medication
Enlargement of the spleen (Felty syndrome)
Pregnancy complications, such as increased risk of premature delivery

Mental Health and Cognitive Issues Related to Rheumatoid Arthritis

Mental health conditions like anxiety, depression, and bipolar disorder are not uncommon among people with arthritis, RA included.

For example, in a study from 2018, researchers found that 55 percent of adults age 50 or older who had minor depression also had arthritis. Those rates jumped to 62.9 percent and 67.8 percent for geriatric arthritis patients experiencing moderate and severe depression, respectively.

Research presented in 2019 showed a similar link between arthritis and mental health issues. In one study, researchers found that 10 percent of patients with rheumatic and musculoskeletal diseases surveyed had suicidal thoughts. Another study found that 25 percent of patients with RA or adult juvenile idiopathic arthritis experienced anxiety or depression.

Study participants also noted marked sleeping issues due to pain.

Researchers have also investigated the link between mental health issues and RA, specifically. A 2018 study found that the incidence of depression, anxiety, and bipolar disorder was higher in people with RA than those without RA by 45 percent, 25 percent, and 20 percent, respectively.

There is also some evidence that having RA increases the risk of dementia. People with RA may have a 61 percent increased risk of dementia compared with the general population, according to a review from 2016.

Another study a year later suggested that the commonly used DMARD drugs may play a role in the development of dementia.

Yet, biologic or targeted synthetic DMARDs may decrease the risk of dementia by 17 percent compared with conventional DMARDs, according to research presented in 2020.

More research is needed, however, as other studies have shown conflicting results, including a decreased risk of Alzheimer’s disease for RA patients (dementia is a symptom of Alzheimer’s disease)

and a reduced risk of dementia for patients using DMARDs.

Does Rheumatoid Arthritis Cause Cancer?

People with RA are known to have an increased risk of lymphomas (cancer of the lymph nodes), particularly non-Hodgkin lymphoma. The overall incidence of lymphomas among people with RA is almost twice as high as in the general population, research shows.

Studies have suggested that newer versions of DMARDs, called biologic DMARDs, may be partly to blame. But a large study from 2017 showed that RA treatment doesn’t affect lymphoma risk.

A Swedish cohort study reported in 2021 that biologic DMARDs do not further increase lymphoma risk in RA patients. In fact, the drugs may actually reduce “excess lymphoma risk,” the researchers noted.

As is the case with many other RA comorbidities and complications, the increased lymphoma risk is likely the result of uncontrolled RA inflammation, the research suggested.

Editorial Sources and Fact-Checking

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