Rheumatoid arthritis (RA) is the most common form of autoinflammatory arthritis, affecting nearly 1.3 million Americans. Almost 75 percent of cases occur in women, and the initial onset of symptoms can happen at any age.
While we don’t know the exact cause of rheumatoid arthritis, the dysregulation of one’s immune system, the system that is supposed to attack anything that does not belong in your body that may be potentially dangerous, is generally believed to be the culprit.
That said, there are many misconceptions about rheumatoid arthritis which stem from the lack of awareness. One of the most common misconceptions is that the disease is limited to the joints. In fact, it can involve other parts of the body as well. In actuality, rheumatoid arthritis is a systemic process and can often present with extra-articular manifestations (symptoms other than arthritis) and can involve any part of the body, including, but not limited to, the heart, lungs, and eyes.
Inflammation increases the risk of heart disease and cardiovascular morbidity/mortality. Other manifestations of the heart affected by RA include the presence of inflammation within the heart tissue (myocarditis) or around the heart tissue (pericarditis).
Similar to how inflammation can cause permanent irreversible joint damage, inflammatory changes in the lungs can lead to irreversible lung scarring and decreased respiratory capacity termed as Interstitial Lung Disease. If this is not recognized in its early stages, lung scarring can progress, requiring patients to use oxygen as they would with severe emphysema.
Inflammation in the eyes, Uveitis, can also occur in patients with RA. This presents predominantly with tender, irritable eyes with or without a change in vision. It is important to be aware of these symptoms and notify your physician, as it can drastically change your treatment plan.
A second misconception is that RA can be seen. Actually, one can have a severe form of the condition without “looking ill,” and individuals are often able to carry out their activities of daily life despite having active symptoms.
Systemic autoinflammatory conditions, including RA, often times may be “hidden” as they do not display clear signs such as some skin conditions like plaque psoriasis. This can understandably be frustrating for patients as they may be surrounded by uninformed individuals who unknowingly undermine their “hidden condition.”
Although much work lies ahead to increase awareness and clear misconceptions of autoinflammatory conditions, I am hoping that with increased dialogue between patients and physicians, we can shed light on these often-misunderstood conditions.
Mohammed Ursani, MD, is a practicing rheumatologist with Millennium Physicians in Kingwood, Texas. Dr. Ursani is triple board-certified in rheumatology, musculoskeletal ultrasound in rheumatology, and internal medicine. He is currently a member of the American College of Rheumatology’s Communications & Marketing Committee.