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Symptoms and Comorbidities of Rheumatoid Arthritis - An Overview
Posted on
26.9.2024
Edited on
27.9.2024
Contents
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that mainly affects the joints. In RA, the immune system mistakenly targets healthy structures in the joint: the synovium or synovial membranes.
The primary symptoms of rheumatoid arthritis are noticeable in the musculoskeletal system. They are diverse and vary in intensity and frequency.
In addition, rheumatoid arthritis can cause systemic symptoms. These can occur throughout the entire body and manifest themselves in accompanying illnesses (comorbidities). These symptoms also vary in intensity and frequency.
This article provides an overview of rheumatoid arthritis symptoms and highlights possible comorbidities.
joint pain and swelling
The most common symptom of rheumatoid arthritis is pain and swelling in the affected joints. These symptoms occur in almost all patients and are characteristic of the disease.
The inflammation in the joints causes tissue thickening and the production of excess synovial fluid. This causes swelling and pain.
The small joints of the hands and feet are most commonly affected. But larger joints such as knees, hips or shoulders can also be affected. The pain is usually symmetrical, meaning it affects both halves of the body equally.
Joint stiffness & morning stiffness
Another common symptom is the stiffness of affected joints. Stiff joints occur particularly after periods of rest, such as after sleeping in the morning. This is why it is also referred to as morning stiffness.
Joint stiffness in rheumatoid arthritis can last from a few minutes to several hours. It is caused by an accumulation of inflammatory cells and fluid in the joints.
With advanced disease or in acute attacks, this stiffness can last longer and significantly affect the daily lives of those affected.
Exhaustion (fatigue)
Another common accompanying symptom is chronic exhaustion, also known as fatigue. In rheumatoid arthritis, fatigue is probably due to the increased physical strain caused by systemic inflammation. Systemic inflammation not only affects a localised area, but the whole body.
Certain messenger substances, the so-called pro-inflammatory cytokines, play a role in the immune response. They presumably promote this form of fatigue in rheumatoid arthritis by influencing the central nervous system.
Cytokines that have gained attention in the scientific community are tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6). These cytokines are inhibited in the treatment of rheumatoid arthritis with biologics, among other things, in order to alleviate the immune response and associated symptoms.
Loss of joint function and deformities
As RA progresses, permanent joint damage can occur, resulting in loss of joint function. This occurs when the inflammation in the joint becomes chronic and the cartilage and bone are destroyed.
In severe cases, joint deformities can occur, which are characterised by a misalignment of the joints. Well-known deformities are swan neck deformity and buttonhole deformity, which mainly affect the fingers.
Rheumatoid nodules
Subcutaneous nodules develop in around 20-30% of patients. These lumps under the skin are known as rheumatoid nodules. They typically occur at pressure points such as the elbows, forearms or hands.
Rheumatoid nodules consist of inflammatory tissue and are a sign of a more severe form of the disease. They are caused by chronic inflammation and the resulting tissue reaction.
Fever and weight loss
In less frequent cases, there may be a slight fever and unintentional weight loss. These symptoms are an expression of the systemic inflammatory reactions in the body and often occur in conjunction with acute flare-ups of the disease.
Depression and anxiety
Psychological side effects such as depression and anxiety are not uncommon in RA patients. The chronic nature of the disease, the persistent pain and the physical limitations contribute to a higher prevalence of mental disorders in people with RA. In addition, the inflammatory processes can also directly affect the central nervous system and lead to neuropsychiatric symptoms.
Systemic concomitant diseases
The most common symptoms of rheumatoid arthritis occur in or around the joints. However, studies show that rheumatoid arthritis can increase the risk of secondary diseases. This is also referred to as comorbidity.
Cardiovascular diseases
Rheumatoid arthritis is associated with a greatly increased risk of cardiovascular disease. According to studies, the risk is twice as high as in people who do not suffer from RA [11,12].
This is because chronic inflammation promotes the formation of plaques in the arteries [12]. In medical terms, these deposits are known as atherosclerosis. This increases the risk of heart attacks and strokes. Inflammation can also affect the heart muscle or pericardial tissue, which can lead to pericarditis.
Lung problems
Many RA patients develop lung problems during the course of the disease [13]. These are often due to damage to the connective tissue of the lungs [14]. This is referred to as interstitial lung disease, or ILD for short.
ILDs comprise more than 200 diseases. Initial symptoms are often non-specific. They include coughing or breathlessness on exertion. If such symptoms occur, they should be discussed with the treating physicians in order to speed up the diagnosis and initiation of treatment.
Eye diseases
In 8-30% of cases, rheumatoid arthritis can also affect eye health. If inflammatory reactions occur in the eye area, this can lead to dryness of the eyes and inflammation. According to studies, the wetting of the eye surface is more frequently disturbed in RA patients.
The risk of developing Sjögren's or sicca syndrome is also increased in patients with rheumatoid arthritis [15,16].
Diseases of the skin and bones
Secondary diseases of the skin and bones can also occur.
According to studies, rheumatoid arthritis manifests itself in the skin in 15-25% of patients during the course of the disease [17]. These manifestations can include rheumatoid nodules or rheumatoid nodules, vasculitis and Sweet's syndrome (neutrophilic dermatosis).
Less frequently, vascular changes, ulcers on the legs or Raynaud's syndrome may occur. Psoriasis also occurs more frequently in RA patients than in non-RA patients.
In 30-80% of cases, rheumatoid arthritis also manifests itself in bone health [18-20].
Long-term inflammation and the use of glucocorticoids to treat RA can lead to a decrease in bone density and an increased susceptibility to osteoporosis. Osteoporosis is a disease characterised by a decrease in bone density and increased bone fragility. This is a common complication in RA patients and increases the risk of bone fractures.
The symptoms of rheumatoid arthritis are varied and affect not only the joints, but the entire body. Joint pain and stiffness are among the most common symptoms, while systemic effects such as lung involvement, cardiovascular disease and osteoporosis can be serious complications. The origin of these symptoms lies in chronic inflammation caused by dysregulation of the immune system. Early diagnosis and treatment is crucial to slow the progression of the disease and improve the quality of life of those affected.
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What is fatigue?
Fatigue describes a state of intense and prolonged exhaustion that can manifest on physical and mental levels. Fatigue can occur as a symptom of various diseases or as an independent syndrome.
Raynaud's syndrome
Whitish discolouration and a feeling of cold in the fingers or other limbs may indicate Raynaud's syndrome. A distinction is made between primary and secondary Raynaud's syndrome.
Drug treatment of rheumatoid arthritis
Treatment for RA aims to control inflammation, slow the progression of the disease, reduce pain, and maintain the functionality of affected joints. Drug therapy is an essential part of the treatment concept.
