Complications

• Miscellaneous:
• Vasculitis, vasculitic ulcers.
• Pleurisy/pleural effusions, pulmonary fibrosis.
• Pericarditis.
• Dry eye syndrome (keratoconjunctivitis sicca).
• Neuropathy.
• Felty's syndrome (enlarged spleen and low white blood cell count) — this can present with infection or leg ulcers.
• Amyloidosis (rare).
• Anaemia:
• People with rheumatoid arthritis (RA) can have any type of anaemia. About 77% have anaemia of chronic disease and 23% have iron deficiency anaemia (possibly related to nonsteroidal anti-inflammatory drugs [NSAIDs] and oral corticosteroids).
• Orthopaedic problems:
• Carpal tunnel syndrome.
• Tendon rupture (particularly extensors of fingers or thumb).
• Cervical myelopathy (usually after severe and long-term RA), which often has an insidious onset, with deteriorating mobility and upper limb function, peripheral paraesthesia, hyperreflexia, and sphincter disturbance. Early referral for surgical decompression and stabilization can prevent deterioration and long-term morbidity.
• Infections:
• RA is associated with an approximate doubling of the risk of infection; chest infection and generalized sepsis are particular risks.
• Drugs such as corticosteroids and immunosuppressants increase the risk of opportunistic and other serious infection.
• Septic arthritis is a rare but serious complication.

Comorbidities

• Cardiovascular disease (CVD):
• People with RA are at increased risk of CVD.
• The drugs used to treat RA can cause problems with hypertension (NSAIDs), high blood sugar and lipids (corticosteroids), platelet aggregation (coxibs) and increased homocysteine, which is linked with thrombosis (methotrexate, especially when sulfasalazine is co-administered).
• Homocysteine levels can be reduced by folic acid supplementation, which is given to people prescribed methotrexate for RA.
• Depression and anxiety.
• Osteoporosis:
• Corticosteroids are an important cause of osteoporosis, but RA also increases the risk of osteoporosis in the absence of corticosteroid use.
• Gastrointestinal disease:
• Upper gastrointestinal problems are increased in people with RA. This is mainly due to the adverse effects of NSAIDs.
• Malignancy:
• Leukaemia, lymphoma, and multiple myeloma are more common in people with RA. This is thought to be due, in part, to the use of disease-modifying anti-rheumatic drugs (DMARDs).
• RA itself predisposes to lymphoproliferative diseases (particularly lymphoma).