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Monday, May 30, 2011

RA- beyond the joints - what else is effected?

     Even though we tend to totally focus on the joint issues associated with Rheumatoid Arthritis, we need to be mindful of the fact that RA has its impact on the entire body.  Why?  Well, remember RA is an autoimmune disease characterized by inflammation which seems to be the culprit in many health issues we face today from heart disease to cataracts.  
     Studies and reports from patients indicate that the severity and incidence of the different problems I will mention are often related to the severity of the RA, how long you have had the disease, and how well it is controlled by medications and other treatments.  So take heart because that is the really good news and I am always looking for and hanging onto the good news!
     So, what are some of the issues? Let's talk eyes first.  

Some people with rheumatoid arthritis may develop an inflammation of the eyes known as scleritis. Symptoms include pain, redness, blurred vision and light sensitivity. Treatment is usually eye drops, NSAIDs or a corticosteroid. 
In rare cases, scleritis causes pigment changes in the retina. RA can also cause uveitis, an inflammation of the area between the retina and the white of the eye, which, if not treated, could cause blindness. Corticosteroids may cause glaucoma and cataracts.  I just found out about a month ago that I have them in both eyes but so far just adjusting my prescription in my glasses is doing the job so surgery is hopefully a few years away!  As a rule, people with RA should get eye checkups at least once a year.
     Our skin is another body organ impacted by RA.  
About half of the people with RA develop rheumatoid nodules – lumps of tissue that form under the skin, often over bony areas exposed to pressure, such as fingers or elbows. Unless the nodule is located in a sensitive spot, such as where you hold a pen, treatment may not be necessary. Nodules sometimes disappear on their own; disease-modifying antirheumatic drugs (DMARDs), a category of drugs that inhibits the disease process, can cause them to vanish as well.  Mine tend to come and go and are not painful.  However, I do have some persistent issue at my wrists and had to have surgery there.  Skin is also susceptible to RA drugs. Corticosteroids, which mimic the naturally occurring hormone cortisol to control inflammation, can cause thinning of the skin and susceptibility to bruising.  I take a small dose now every day and I have definitely noticed easier bruising. Non-steroidal anti-inflammatory drugs (NSAIDs), which treat inflammation, and Methotrexate, a widely prescribed DMARD, can cause sun sensitivity but I really have not noticed it myself (maybe living in the northern climate accounts for that). People taking biologic response modifiers, or biologics, a sub-category of DMARDs designed to stop inflammation at the cellular level, may develop a rash at the injection site but I have NEVER had one and I have been either injecting or having infusions for 9 years now.  I do get some odd skin rashes which I attribute to the inflammatory nature of RA.  I have some ointments and that and time take care of it.  I did get shingles once and my Primary Care Physician definitely felt that my compromised immune system was, if not completely certainly partly, responsible.  We caught it early and I really did not suffer much with it.

     The mouth is an interesting topic.  Methotrexate can cause mouth sores or oral ulcers so most doctors recommend folic acid and that has worked for me 100%.  No one knows why, but people with RA tend to have a higher rate of gum disease, or gingivitis. Excellent oral hygiene is a must.  For treatment of the ulcers try a topical pain reliever or ask your doctor or dentist for a prescription mouthwash.
 One of the more scary organs impacted are the lungs. About a third of people with RA will develop some type of lung or pulmonary symptom. Pleurisy, an inflammation of the lung lining, can make it painful to take a deep breath but is treatable with anti-inflammatory drugs. Some people with RA develop scarring called pulmonary fibrosis, which leads to progressive shortness of breath. Rheumatoid nodules might form in the lungs, but are usually harmless. RA drugs may affect the lungs as well. Methotrexate can cause a complication known as methotrexate lung or methotrexate pneumonia, which generally goes away when the methotrexate is stopped. The condition goes away when treatment ceases; patients can usually resume the drug in a few weeks.  The risk of contracting tuberculosis (TB – a bacterial infection of the lungs), is elevated in people with RA and intensifies among those taking corticosteroids, DMARDs and biologics. Your doctor should test for TB before initiating treatment and periodically after.

     Our hearts health is also effected by RA.   Research
 shows that people with RA are about 2.5 percent more likely to develop cardiovascular disease than the general population. Researchers suspect it’s because the inflammation that characterizes RA spreads to blood vessels. RA can also cause pericarditis, inflammation of the heart lining, which may manifest as chest pain. In general, people with RA should address lifestyle factors associated with heart disease such as eating a healthy diet, exercising and not smoking.  It just motivates me to lead a healthier life and that is not a bad thing! 
     Liver and kidney issues can be avoided by close monitoring by your physcians.  Liver 
diseases may occur with long-term methotrexate use. Working with your rheumatologist to monitor your blood is key to preventing problems. 
Kidney problems are more likely related to side effects of RA drugs – such as cyclosporine or an NSAID – than to the disease itself. If you're taking one of these drugs or methotrexate, which concentrates in the kidneys, your doctor will monitor your kidney function to watch for problems.
     Our blood blood vessels can be impacted due primarily to the inflammation associated with RA.  Letting the inflammation go unchecked can cause anemia - a reduction
in red blood cells characterized by headache and fatigue. Inflammation might also lead to thrombosis, or elevated blood platelet levels, and blood clots. Both conditions improve as the inflammation is controlled; anemia can be further addressed with iron supplements. On the other hand, aggressively treating inflammation with corticosteroids may cause thrombocytopenia, an abnormally low number of blood platelets. This, too, is addressed by stopping the medication.  It
’s rare, but longstanding RA can also cause vasculitis, inflammation of small blood vessels that supply the skin. Such involvement may have serious consequences if not addressed, although aggressive treatment with methotrexate, corticosteroids and other drugs that control cell production usually resolves the problem. Vasculitis is often heralded by small red dots on the skin; more severe cases can cause ulcers on the legs, under fingernails or in nail beds.  

     Our nervous systems don't escape either. N
erve problems in the arms or legs, such as numbness, tingling or weakness, sometimes occur with RA. People with RA may develop carpal tunnel syndrome, a common nerve condition in which the nerve that runs from the forearm to the hand is compressed by inflamed tissue, resulting in tingling, numbness and decreased grip strength.  This was never a problem for me until about a year ago but now I use braces to alleviate the discomfort and it comes and goes, like most of the symptoms of RA. 

    Sjogren's Syndrome is a pesky problem that many of us suffer from who have RA.  We are at greater risk for Sjögren’s syndrome, a condition in which the immune system attacks the body’s moisture-producing glands. The result: eyes and mouth that feel dry and gritty. Dry eyes can be relieved with “artificial tear” eye drops. In severe cases, a surgical procedure to plug the tear ducts may help but that did not work for me and frankly since it comes and goes I just use drops as needed.  If left untreated, the condition can result in eye infection and scarring of the conjunctiva – the membrane covering the white of the eye inside the eyelid. Prescription medications can stimulate saliva production in our mouth but I just did not want yet another med and since sucking on hard candy (sugarless recommended) works as well that is what I do. Good dental hygiene is a must, as bacteria tend to flourish in a dry mouth, leading to tooth decay and gum disease so make sure you see your dentist often if you have Sjogren's.
     There has been much discussion and reporting on the increased incidence of lymphoma (cancer) in RA patients, especially those taking the new biologics.  Although there is a slight increase in the rate of cancer among RA patients, lifestyles choices once again play a role as exercising, diet and making healthy lifestyle choices are a big factor.  As to the biologic piece, the latest studies do not support this and have shown that there is no significant difference in the incidence of cancer between those using the biologics and those who do not.
    WOW, if you look at this you may think that our lives are doomed but the fact is that the big take away message from all of this is that early and proper treatment, getting and staying educated and informed, a healthy lifestyle filled with exercise, a good diet, proper sleep, recreation, a support system of loved ones and medical personnel and trying to keep stress levels low will mitigate most of these!  So, start now and take control.  Your health depends on it and as does the successful management of your RA.
Take a walk, ride a bike, enjoy a movie today!

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