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Although the primary symptom of rheumatoid arthritis is
joint pain and reduced mobility, the dysfunction of the
immune system that causes it to attack the joints is
not joint-specific—it can cause the immune cells to attack other tissues as
well. The other organs most commonly affected are the skin, the lungs, and the
blood vessels. Sometimes the heart, brain, and even the cells of the
immune system can be affected, causing additional medical problems. But it is
rare to suffer from significant non–joint-related symptoms.
most common symptom of rheumatoid arthritis outside of the joints is the
presence of what are called rheumatoid nodules. These are small lumps of soft
tissue that can be felt beneath the skin, most commonly over the elbows.
Skin changes may
also occur in rheumatoid arthritis because of blood vessel inflammation
(vasculitis). Skin changes may include raised, painless red to purple knots on
the skin, especially over the legs and arms; painful, red to black areas that look like pimples around the finger and toenails; and rarely, skin ulcers on the lower
rheumatoid arthritis progresses, lung problems may be experienced as shortness
of breath at rest or with exertion, chest pain upon breathing (pleurisy), and
The same process that damages the blood vessels (vasculitis) may affect
nerves, leading to loss of sensation or strength; the gut, resulting in
internal bleeding; the eyes, causing redness, pain, and sometimes loss of
vision; and many other organ systems of the body.
may also be associated with other
autoimmune disorders, such as thyroid gland problems,
salivary gland inflammation (causing dry eyes and dry mouth, known as "sicca
syndrome"), and increased destruction of certain types of blood cells.
The joint inflammation
itself may damage adjacent structures, leading to compression of certain
Carpal tunnel syndrome is one type of nerve damage
caused by increased pressure on the nerve.
Felty's syndrome is a rare complication of
rheumatoid arthritis in which the spleen is enlarged. There is also increased
destruction of particular white blood cells by the immune system. These white
blood cells are important in fighting infection. People with Felty's syndrome
are more susceptible to certain bacterial and fungal infections.
Non-joint symptoms of rheumatoid arthritis, such as lung, heart, nerve
and eye involvement, are relatively uncommon. While rheumatoid arthritis is
overall more common among women, non–joint complications occur equally in men
and women, indicating that men are at higher risk. The presence of these
symptoms may indicate that a person is at risk of developing other rheumatoid
In many ways, the average person may
be at greater risk of having problems secondary to arthritis itself rather than
as a direct result of the disease process. Arthritis diminishes mobility if not
well controlled, leading to general deconditioning, which makes it more
difficult for people to get around and lose weight. As people decrease their
activities, their symptoms get worse. As they become less active, they may
become homebound and sometimes even bed-bound, both of which limit their
ability to care for themselves. Some are at greater risk for infections, such as pneumonia, because of diminished mobility and a sedentary
lifestyle. Others are at risk for falls due to muscular weakness. With falls
comes the risk of fracture and fracture complications. The best way to
prevent such complications is to treat the arthritis early and aggressively to
help maintain a person's function to the greatest degree possible.
June 5, 2012
Anne C. Poinier, MD - Internal Medicine
& Nancy Ann Shadick, MD, MPH - Internal Medicine, Rheumatology
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