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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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As a rule, the severity of rheumatoid arthritis waxes and wanes. Periods of active inflammation and tissue damage marked by worsening of symptoms (flares) are interspersed with periods of little or no activity, in which symptoms get better or go away altogether (remission). The duration of these cycles varies widely among individuals.

Outcomes are also highly variable. Some people have a relatively mild condition, with little disability or loss of function. Others at the opposite end of the spectrum experience severe disability due to pain and loss of function. Disease that remains persistently active for more than a year is likely to lead to joint deformities and disability. Approximately 40% of people have some degree of disability 10 years after their diagnosis. For most, rheumatoid arthritis is a chronic progressive illness, but about 5%-10% of people experience remission without treatment. This is uncommon, however, after the first three to six months.

Rheumatoid arthritis is not fatal, but complications of the disease shorten life span by a few years in some individuals. Although generally rheumatoid arthritis cannot be cured, the disease gradually becomes less aggressive and symptoms may even improve. However, any damage to joints and ligaments and any deformities that have occurred are permanent. Rheumatoid arthritis can affect parts of the body other than the joints.

The early use of DMARDs and biologic response modifiers in rheumatoid arthritis has resulted in patients experiencing more profound relief of symptoms and less joint damage and less disability over time.

Common complications of rheumatoid arthritis include the following:

• Peripheral neuropathy and carpal tunnel syndrome: This condition results from damage to nerves, most often those in the hands and feet. It can result in tingling, numbness, or burning.
• Anemia: This is a low level of hemoglobin, a protein in the blood that carries essential oxygen to cells and tissues. Symptoms include weakness, low energy, pallor, and shortness of breath.
• Scleritis: This is a serious inflammation of the blood vessels in the white portion (sclera) of the eye that can damage the eyes and impair vision.
• Infections: People with rheumatoid arthritis have a higher risk for infections. This is due partly to the abnormal immune system in rheumatoid arthritis and partly to the use of immune-suppressing medications for treatment.
• Digestive tract problems: Many people experience stomach and intestinal distress. Again, this is more often a side effect of medications used to treat rheumatoid arthritis.
• Osteoporosis: Osteoporosis, or the loss of bone density, is more common in women with rheumatoid arthritis than in women in general. The hip is particularly affected. The risk for osteoporosis also appears to be higher than average in men with rheumatoid arthritis who are older than 60 years.
• Lung disease: Certain conditions involving inflammation of the lungs seem to be more common in people with rheumatoid arthritis than in the general population. These include pleurisy and pleuritis, lung infections, lung nodules, and pulmonary fibrosis. However, a definite link between cigarette smoking and rheumatoid arthritis may at least partly account for this finding. Cigarette smoking, in any case, may increase the severity of the disease.
• Heart disease: Rheumatoid arthritis can affect the blood vessels and may increase the risk for coronary heart disease.
• Sjögren's syndrome: This is another autoimmune rheumatic disease, like rheumatoid arthritis. It causes extreme dryness of certain body tissues, especially the eyes and mouth. Dryness of the eyes is common in people with rheumatoid arthritis.
• Felty's syndrome: This condition combines enlargement of the spleen with impairment of the immune system (low white blood cell count), leading to recurrent bacterial infections. This syndrome sometimes responds to DMARD therapy.
• Lymphoma and other cancers: The risk for lymphoma, a cancer of the lymph nodes, is higher than normal in people with rheumatoid arthritis. This is thought to be a result of abnormalities in the immune system. The risk of lymphoma is higher in those patients with active inflammatory disease. Other cancers that may be more common in people with rheumatoid arthritis include prostate and lung cancers.
• Macrophage activation syndrome: This is a life-threatening complication of rheumatoid arthritis. It is diagnosed by bone marrow testing and requires immediate treatment. Symptoms include persistent fever, weakness, drowsiness, and lethargy.

Overall, the rate of premature death is higher in people with rheumatoid arthritis than in the general population. The most common causes of premature death in people with rheumatoid arthritis are infection, vasculitis, and poor nutrition. Fortunately, the manifestations of severe, long-standing disease, such as nodules, vasculitis, and deforming are becoming less common with optimal treatments.

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