Some eight percent of people with RA develop interstitial lung disease, or scarring of the lungs, compared with only 1% to 2% of the general population, says Eric L. Matteson, MD, chair of rheumatology at the Mayo Clinic, in Rochester, Minn.
In addition to the joints, RA can attack the lungs and cause scarring. Over time, this can make breathing difficult. RA treatments such as methotrexate and glucocorticosteroids can increase the risk of interstitial lung disease.
People with RA may also develop inflammation in the lining of the lungs, or pleurisy, which can make breathing painful, and lung nodules, which can be mistaken for cancer.
What to do: If you are having difficulty breathing, talk to a doctor immediately.
RA drugs such as methotrexate, adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) suppress the immune system, boosting the risk of infection. That’s on top of an already-increased risk due to the disease itself. “Just having rheumatoid arthritis approximately doubles your infection risk independent of treatment,” says Dr. Matteson.
One risk is tuberculosis (TB), although it is less common in the U.S. than in developing nations.
What to do: Doctors routinely perform a skin test to check for TB before starting a person on immune-suppressing drugs, Dr. Fiocco says. If the test is positive, the doctor will treat the infection first.
Not surprisingly, depression affects more people with RA—perhaps up to twice as many—than those who don’t have the condition. Having to cope with RA in addition to functional disability, loss of independence, and decrease in quality-of-life all contribute to depression, Dr. Fiocco says.
What to do: One small study showed that only 1 in 5 RA patients talk to their doctor about depression. If you have symptoms of depression, get help. According to Dr. Fiocco, with the newer [RA] medications, a lot more quality of life is being maintained these days.
RA can lead to anemia, which is a lack of red blood cells needed to transport oxygen in the body. RA inflammation can suppress the bone marrow that generates red blood cells.
“Anemia is directly related to the activity of the disease,” says Dr. Fiocco. “High levels of inflammation lead to greater degrees of anemia and these are closely correlated. Medication can also exacerbate the problem.”
What to do: If the anemia is due to inflammation, getting it under control will help, Dr. Matteson says. Drugs that spur red-blood-cell production can help too. And if you’re iron deficient, consider iron supplements, but keep in mind that highly active RA can inhibit iron absorption.
Another RA complication is gastrointestinal problems, primarily bleeding in the digestive tract and ulcers. This can be due to nonsteroidal anti-inflammatory drugs (NSAIDs), now available both over-the-counter (Advil or Aleve) and by prescription (Celebrex).
“The combination of NSAIDs plus steroids makes it even worse,” Dr. Fiocco says. GI bleeding can also cause or worsen anemia. If you’re taking a prescription NSAID, you should be monitored for this side effect.
What to do: If you’re taking an over-the-counter NSAID, stick to the recommended dosage and don’t take more than one NSAID, including aspirin, at a time.