Rheumatoid Disease Morbidity and Mortality Part One

Rheumatoid Disease, also known as Rheumatoid Arthritis, carries with it a myriad of symptoms, comorbidities, and increased mortality rate.

Rheumatoid Disease Ribbon

In a Facebook group, someone recently commented that Rheumatoid Disease is a death sentence. As in most social media, people jumped on her and blasted her for saying it’s a death sentence. However, it can be. Most of the time it’s not, but many of the complications are serious, even life-threatening, and it’s important to not ignore these. I’m going to focus on the lung complications for this post. In later posts, I will focus on other body systems and serious complications.


Lung Disease

Several lung conditions occur in Rheumatoid Disease. Most are caused by inflammation including pleuritis, pulmonary fibrosis, pulmonary rheumatoid nodules, and interstitial lung disease.1https://rheumatoidarthritis.net/symptoms/lung-diseases-and-conditions/


Pleuritis or pleurisy  – the pleura, or the sac surrounding the lungs, becomes inflamed, and often fluid builds up in this sac – pleural effusion. The symptoms of pleurisy include pain with respiration. A pleural effusion can cause shortness of breath including pain on breathing. A large pleural effusion can be an emergency.2https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/expert-answers/rheumatoid-arthritis/FAQ-20058245

While treatable, complications may arise from a pulmonary effusion. If not treated early, it can cause permanent scarring of the lungs.

If you have symptoms of pleural effusion, you should seek medical attention as soon as possible. One study has shown that as many as fifteen percent of people admitted with a pleural effusion die within thirty days of admission.3https://www.healthline.com/health/pleural-effusion

Pulmonary Rheumatoid Nodules

Pulmonary Rheumatoid Nodules are small lumps. They can also develop in other areas of the body and will be addressed more in-depth in a separate post. They usually have no signs and symptoms however they may rupture and cause a collapsed lung.4https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/expert-answers/rheumatoid-arthritis/FAQ-20058245

Interstitial Lung Disease

ILD, or interstitial lung disease, is a group of disorders that cause inflammation and scarring when the immune system attacks the lungs. It’s hard to diagnose because the symptoms of a dry cough and shortness of breath don’t show up until extensive damage is done. It’s estimated that one in ten people with Rheumatoid Disease will develop interstitial lung disease.

Those who are diagnosed and treated early may be put on the waiting list for a lung transplant sooner.

ILD is difficult to diagnose and difficult to treat. Once it’s diagnosed, the life expectancy is 2.6 years.5http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/articles/lung-disease-rheumatoid-arthritis.php

While the lung complications aren’t common, they do happen. It’s important to know and recognize the symptoms. The earlier lung complications are treated, the better the outcome.










Rheumatoid Arthritis


 Rheumatoid Arthritis

A look at symptoms

RA or Rheumatoid Arthritis is a poly-inflammatory arthritis meaning it causes swelling and pain in more than one joint.

It’s not your granny’s arthritis. While Osteoarthritis can develop in patients with Rheumatoid Arthritis, they are two distinct processes.

Rheumatoid Arthritis is an autoimmune disease. This means the patient’s immune system is malfunctioning and attacking the patient’s joints.  Since RA is a systemic disease, it can affect the heart, lungs, eyes, blood vessels, neurological system,  and even the blood components.

Symptoms of RA are usually insidious. At first the patient will have fatigue, loss of appetite, weakness, low-grade fever, and vague musculoskeletal symptoms.

As the disease progresses, the patient develops pain and swelling in multiple joints.  This usually happens in a symmetrical pattern–both hands, both feet, both knees. All joints may be affected by the disease.

The joints become painful, tender, and stiff. Morning stiffness lasts more than an hour and can last several hours. The stiffness of Rheumatoid Arthritis is nothing like muscle stiffness or joint stiffness from over-use. It’s much worse and can affect the person’s gait due to stiffness in the joints of the feet.

Possible symptoms of RA include:

  • Fatigue – The fatigue associated with RA is not relieved by rest. In fact, many times the patient wakes more fatigued than when he went to sleep the night before.
  • Joint inflammation – it may start in the joints nearest the hand – the wrists and fingers, but it may involve all of the joints. This inflammation can lead to joint erosion causing increased pain and deformity
  • Fever – Usually a low-grade temperature
  • RA Nodules – Not everyone develops these small bumps of tissue that form under the skin, but those who do, develop them on pressure areas. Nodules vary in size and aren’t usually painful.
  • Tendon inflammation and possible rupture
  • Anemia
  • Ischemic heart disease
  • Pericarditis – inflammation of the sac surrounding the heart
  • Pericardial effusion – fluid in the pericardial sac (sac around the heart).
  • Cardiac Tamponade – compression of the heart muscle caused by fluid in the pericardial sac – can be very serious.
  • Pleural Effusion – fluid accumulation in the sac lining the lungs
  • Pulmonary nodules – nodules forming in the lungs
  • Dry eye syndrome
  • Scleritis – inflammation of the sclera(whites) of the eye.
  • Keratitis – inflammation of the cornea
  • Scleromalacia – Thinning of the sclera of the eye
  • Nodules near nerve roots causing neurological symptoms
  • Cervical spine subluxation – dislocation of the first vertebra of the neck.
  • Hoarseness – caused by Rheumatoid changes in the cricoarytenoid joints (joints of the voice box)
  • Systemic vasculitis – inflammation of the blood vessels
  • Felty’s Syndrome – A syndrome that affects the blood countsBook Ad
  • Increased susceptibility to infection
  • Depression
  • Anxiety

Rheumatoid Arthritis is so much more than “just arthritis”.  This debilitating disease impacts the patient’s life significantly. On average, within ten years from diagnosis, the patient is no longer able to continue working, relationships are impacted because the patient is no longer able to participate in the activities he use to love.

As a systemic disease, RA decreases the life span an average of ten years. In patients with severe disease, untreated disease, or disease affecting the heart, lungs or blood vessels may have a severely decreased life span.


Family Practice Notebook
Harrison’s Rheumatology Second Edition; Editor Anthony S. Fauci