Table of ContentsView AllTable of ContentsMuscles and BonesSkin, Hair, and NailsEyesImmune SystemHeart, Blood, and Blood VesselsLiver and KidneysSpine, Brain, and NervesStomach and GI TractMouth, Nose, and MoreRheumatoid Arthritis Dos and Don’ts
Table of ContentsView All
View All
Table of Contents
Muscles and Bones
Skin, Hair, and Nails
Eyes
Immune System
Heart, Blood, and Blood Vessels
Liver and Kidneys
Spine, Brain, and Nerves
Stomach and GI Tract
Mouth, Nose, and More
Rheumatoid Arthritis Dos and Don’ts
Rheumatoid arthritis (RA) can affect many different body systems, including joints such as the wrists, elbows, shoulders, and spine. It can cause myositis (muscle arthritis), joint inflammation, skin rashes, hair loss, and vision problems, as well as changes to the bones, muscles, skin, eyes, nerves, immune system, and more. The condition can also cause fatigue, a fever, or even a loss of appetite.
RA is a progressive disease mainly affecting joints. According to the American College of Rheumatology,rheumatoid arthritisis the most common type ofautoimmune arthritis, affecting more than 1.3 million Americans.
Yourmusculoskeletal systemprovides the body with movement, stability, form, and structure.This body system is divided into two systems—the muscular system and the skeletal system.
Skeletal System
One of the first indications of RA is inflammation in the small joints of thehandsand feet. Often, RA is symmetrical—affecting both sides of the body at once.
Symmetry is key to diagnosing RA. Sometimes, RA does not cause symptoms on both sides, especially early on in the disease. However, the condition will become symmetrical as RA progresses.
Additional joint symptoms of RA include pain, swelling, stiffness, and tenderness. These are usually much worse in the morning and can last for 30 or more minutes.RA can also cause tingling or burning in the joints.
RA symptoms can affect any of your joints, especially as RA progresses. This includes symptoms in thehands,feet, shoulders, elbows, hips, knees, and ankles.
As RA progresses, it will affect tendons, ligaments, and muscles. These symptoms will eventually lead to range-of-motion problems and difficulty with moving your joints.Long-term inflammationin affected joints will cause those joints to become damaged and deformed.
Having RA can put you at a higher risk forosteoporosis—a condition causing bone loss and weakness.This weakness can eventually lead to bone fractures (breaks).
Ongoing inflammation in your wrists may lead to a condition calledcarpal tunnel syndrome, which can make it harder to use your wrists and hands. This same inflammation can cause weakness and damage the bones of yourneck and cervical spine, resulting in severe, ongoing pain.
Your healthcare provider can order X-rays or other imaging to look for joint or bone damage from RA.
Muscular System
When inflammation makes it harder to move your joints, the attached joints will get weak. Researchers have noted a 25%–75%reduction in muscle strengthhas been observed in people with RA when compared to people without RA of the same ages.
Rheumatoid arthritis can cause specific changes throughout the body, such as joint inflammation and muscle fatigue, but the condition can also affect your overall lifestyle. Many people experience reduced mobility as a result of RA, along with physical weakness that can make daily tasks hard to accomplish and daily living far more challenging.
People with RA can develop a condition called rheumatoidmyositisthat causes various symptoms, including:
While rheumatoid myositis is poorly understood, researchers speculate several causes, including inflammation, the medications used to treat RA, impaired joint flexibility, and reduced activity levels.
Although there is no cure, there are treatments that can help reduce symptoms, including:
How Do You Tell the Difference Between Muscle Pain and Arthritis?
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Theintegumentarysystemincludes the skin, hair, and nails, and RA can affect all three.
Skin
The most common skin problems associated with RA are rheumatoid nodules, skin rashes and ulcers, and skin reactions from the medications used to treat RA.
Rheumatoid nodules
Rheumatoid nodules will vary in size—some are as small as a pea and others are as large as a ping pong ball. They develop under the skin in bony areas like the fingers, ankles, and elbows. Sometimes, nodules can form on the lungs.
RA treatments, includingdisease-modifying anti-rheumatic drugs(DMARDs) and corticosteroids, may help to shrink nodules, but some people might need surgery if nodules get too big, become infected, or are painful.
Skin rash and ulcers
For some people, nodules are a sign ofrheumatoid vasculitis(RV), a condition in which small and medium-sized blood vessels are inflamed. When RV affects the large blood vessels, a painful rash can occur, usually on the legs.
Rashes from RV may appear as red and painful patches or red, itchy dots. The fingertips are the most commonly affected skin area in RA, but any skin area can be affected. If RV is severe, skin ulcers (open sores or wounds) can form and become infected.
Medication side effects
Themedications you take to treat RAcan causeskin problems, including rashes, easy bruising, and skin sensitivity. Medication-related skin rash is usually a sign of an allergic reaction, so it is a good idea to let your healthcare provider know if your skin breaks out and feels itchy.
Some RA medications cause the skin to thin out or interfere with blood clotting, which will result in bruising more easily.
Some RA drugs—like methotrexate 404—can make your skin more sensitive to the sun. You should therefore avoid direct sunlight, wear protective clothing when outdoors, use sunscreen, and avoid tanning beds while on these medications.
Hair
Some people with RA experience hair loss as a disease symptom, and others as a side effect of RA treatment. Fortunately, hair loss tends to be a rare complication and when it does happen, it isn’t severe.RA can thin your hair, but you will not lose it in patches.
One of the most common medications used to treat RA—methotrexate—is responsible forhair loss. This is because it causes cells to stop growing, which includes the cells that cause inflammation along with those that promote hair follicle growth.
A 2019 study found that 24.9% of study participants on methotrexate experienced hair loss, and the majority (60%) were women.
Nails
While there isn’t a lot of research related to RA’s influence on fingernails and toenails, there are studies that have mentioned effects to some degree.
For example, a 2017 report noted various nail abnormalities with RA, including:
One German study mentioned in this report found that around 27% of people had nail changes related to RA.
Your ocular system consists of your eyes and its central visual system. RA can cause numerous eye problems, including dry and inflammation-related conditions likekeratoconjunctivitis sicca,scleritis, anduveitis.
Symptoms that indicate RA has affected your eyes include:
If you experience eye symptoms with RA, let your rheumatologist know and make an appointment to see an eye care specialist. Everyone with RA should have their eyes regularly checked to identify eye problems early.
Yourimmune systemis made up of a complex network of organs, cells, and tissues that work together to fight off infections and other diseases. RA is caused when the immune systemattacks healthy jointsbecause it thinks they are foreign invaders.
RA also increases your risk of all types of infections and rises with the severity of RA. With mild disease, your risk increases almost threefold, while severe RA raises the risk nearly fivefold.Because the immune system is busy attacking joints and healthy tissues, it is too busy to protect you against infection.
The medications you take for RA will also increase your risk of infection because they suppress immune system responses.Corticosteroidspose the highest risk, according to a study reported in 2016 in the journalPLoS Medicine.
Thecirculatory system—also called the cardiovascular system or the vascular system—is the organ system that allows for blood circulation and transport of oxygen, hormones, nutrients, carbon dioxide, and blood cells in the body to provide nourishment, help with fighting disease, and stabilizing body temperatures and pH levels.
RA can increase your risk of developing two major diseases of the circulatory system: heart disease and vasculitis.
Heart Disease
People with RA have a higher risk for cardiovascular events—coronary artery disease, heart attack, arrhythmia, heart failure, peripheral artery disease, etc.—especially compared to others in the general population.They also have a higher risk of cardiovascular, respiratory, and all-cause mortality.
Many researchers believe inflammation—the driving force behind RA—is responsible for the increased risk of heart disease and stroke in people with RA.
RA can also causepericarditis, a condition where the sac around the heart is inflamed, andmyocarditis—inflammation of the heart muscle.
Vasculitis
Vasculitisis a serious complication of RA, resulting from ongoing inflammation of the blood vessels.This chronic inflammatory process eventually causes blood vessels to become weak and expand or narrow to the point of reducing or stopping blood flow.
The most commonly affected blood vessels are the arteries responsible for transferring blood to the nerves, skin, heart, and brain. Vasculitis can also affect the veins.
Anemia
RA can also increase your risk for anemia—a condition where the body lacks enough healthy red blood cells to carry sufficient amounts of oxygen to the body’s tissues. The two types of anemia associated with RA areanemia of chronic inflammationandiron deficiency anemia.
Chronic inflammation from RA can lower the production of red blood cells in the bone marrow and release proteins that affect how your body uses iron. Inflammation can also affect the production oferythropoietin, the hormone that regulates the production of red blood cells.
Abnormal Blood Count
Several RA-related issues may arise that can lead to abnormally high or low blood counts. For instance, blood clots can occur due to higher-than-normal blood platelet levels from inflammation. However, treating inflammation with corticosteroids can lead to abnormally low blood platelet levels.
In addition, if you have had RA for a long time, you may be at higher risk for a rare condition called Felty syndrome. The syndrome involves a low white blood cell count and enlarged spleen and can put you at a higher risk for infection and lymphoma.
While RA doesn’t always affect the kidneys and liver directly, treatments for the condition can play a role in changes to these organs.
Studies show that kidney involvement in rheumatoid arthritis happens between 20% and 50% of the time. Most commonly, RA can cause inflammation of the kidneys, a condition calledglomerulonephritis.There are several treatments for glomerulonephritis, including dietary changes and blood pressure medications.
Certain medications for rheumatoid arthritis, including cyclosporine, methotrexate, and non-steroidal anti-inflammatory medications (NSAIDs) can also cause kidney problems. If you are on a medication that can affect your kidneys, your healthcare provider may monitor your kidneys to look for any issues.
Some RA medications may also damage the liver. For instance, long-term use of methotrexate or acetaminophen can lead to liver damage or liver disease.If you take these medications, be sure to talk to your provider about testing to ensure that your liver stays healthy.
RA can affect the central nervous system (CNS), the spine, and the brain. According to a 2015 review, neurological manifestations are quite common in RA, including:
Potential causes of neurological problems include inflammation, nerve compression problems in bones and joints, side effects of medications, and coping problems associated with RA.
If you experience neurological problems related to RA, it is important to let your rheumatologist know. They can do an assessment, offer treatments, and refer you to appropriate specialists.
People with RA experience gastrointestinal (GI) problems. In fact, research shows they struggle more with GI issues than the general population.
RA can affect either the upper or lower section of the GI tract. Research shows that people with RA are about 70% more likely to develop a gastrointestinal problem than people without RA.
Upper GI events may include:
Lower GI problems include:
GI bleeding from ulcers is often due to medications such as NSAIDs.This risk is increased in people who take a combination of NSAIDS and corticosteroids.
Symptoms of GI problems may include:
If you experience GI symptoms frequently, make an appointment to see your healthcare provider so they can determine the source, and provide appropriate treatment.
Lungs and Airways
The respiratory system is the network of organs and tissues that help you to breathe. This system includes the airways, lungs, blood vessels, and the muscles that power the lungs.All of these parts work together to move oxygen through your body and to get rid of waste gases like carbon dioxide.
Studies have confirmed a strong connection between RA and lung problems, including pleurisy, rheumatoid lung nodules, interstitial lung disease, and pulmonary hypertension.
Mouth, Nose, Eyelids and More
Themucous membranesline many tracts and structures of the body and affect multiple body systems. Mucous membranes include the mouth, nose, eyelids, the windpipe, lungs, stomach, intestines, the vagina, and the ureters, urethra, and urinary bladder.
A condition calledSjögren’sdiseasecan affect some of the mucous membranes. Sjögren’s affects between 400,000 and 3.1 million adults in the United States, according to the American College of Rheumatology.
When it issecondaryto a primary cause like RA, it is called associated Sjögren’s disease. A study reported in 2020 found the prevalence of associated Sjögren’s in people with RA is about 30%.
In people with RA, Sjögren’s often affects the tear and saliva glands, leading to:
When Sjögren’s affects the mouth and throat, it can make it hard to eat or swallow. Chronic dry mouth can lead to tooth decay, oral infections, and gingivitis.
Sjögren’s can cause swollen glands in the neck andfaceand dry nasal passages. Women with the condition may experience vaginal dryness.
Given the fact that RA can affect so many body systems, it is important to have a plan for managing the condition. There are a few dos and don’ts that can help you to navigate challenges and overcome obstacles as they arise.
Dos
Dont’s
Summary
Rheumatoid arthritis is a progressive disease that primarily affects the joints. However, RA can also affect many other body systems, such as the musculoskeletal, integumentary, ocular, immune, nervous, respiratory, and circulatory systems. Early diagnosis and treatment can slow RA progression, reduce or prevent its effects on multiple body systems, and improve your quality of life.
Keep your healthcare provider informed of any new symptoms you experience with RA, so they can adjust your treatment as needed. They may request testing to determine the source of new symptoms or refer you to other specialists tohelp manage symptomsand conditions affecting body systems other than the musculoskeletal system.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American College of Rheumatology.Rheumatoid arthritis.Merck Manual.Introduction to the biology of the musculoskeletal system.Johns Hopkins Medicine.Rheumatoid arthritis signs and symptoms.Centers for Disease Control and Prevention.Rheumatoid arthritis.National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).Bone health and osteoporosis.Yamada T, Steinz MM, Kenne E, et al.Muscle weakness in rheumatoid arthritis: the role of ca2+ and free radical signaling.EBioMedicine. 2017;23:12-19. doi:10.1016/j.ebiom.2017.07.023Rheumatoid Arthritis: Learn More – Everyday Life with Rheumatoid Arthritis. Institute for Quality and Efficiency in Health Care (IQWiG); 2024.Arthritis Foundation.Myositis.National Institute of Arthritis and Musculoskeletal and Skin Diseases.Rheumatoid arthritis: diagnosis, treatment, and steps to take.Mount Sinai.Muscle aches.Arthritis Foundation.What is arthritis?Ghosh SK, Bandyopadhyay D, Biswas SK, Darung I.Mucocutaneous manifestations in patients with rheumatoid arthritis: A cross-sectional study from Eastern India.Indian J Dermatol. 2017;62(4):411-417. doi:10.4103/ijd.IJD_260_17Arthritis Foundation.Arthritis medications and hair loss.Łukasik A, Kozicka K, Wojas-Pelc A.The influence of methotrexate on hair loss while using immunomodulatory doses. Pol Merkur Lekarski. 2019 Feb 28;46(272):77-79. PMID: 30830893.Bhamra MS, Gondal I, Amarnani A, et al.Ocular manifestations of rheumatoid arthritis: implications of recent clinical trials.Int J Clin Res Trials. 2019;4(2):139. doi:10.15344/2456-8007/2019/139Arthritis Foundation.Arthritis and infection risk.Rostaing L, Malvezzi P.Steroid-based therapy and risk of infectious complications.PLoS Med. 2016;13(5):e1002025. doi:10.1371/journal.pmed.1002025Institute for Quality and Efficiency in Health Care (IQWiG).How does the blood circulatory system work?Houge IS, Hoff M, Thomas R, et al.Mortality is increased in patients with rheumatoid arthritis or diabetes compared to the general population - the Nord-Trøndelag Health Study.Sci Rep. 2020;10(1):3593 doi:10.1038/s41598-020-60621-2Arthritis Foundation.Rheumatoid Arthritis and Heart Disease.Cojocaru M, Cohocaru IM, Chico B.New insight into the rheumatoid vasculitis. Rom J Intern Med. 2015 Apr-Jun;53(2):128-32. doi: 10.1515/rjim-2015-0017Handono K, Anggraeny O, Sutrinsnani CS, et al.The correlation between the molecular heterogeneity of prolactin and autoantibody and complement levels in patients with systemic lupus erythematosus.Arch Rheumatol. 2014;29(1):035-041. doi:10.5606/tjr.2014.3832Zhang Y, Wang L, Dey S, et al.Erythropoietin action in stress response, tissue maintenance and metabolism.Int J Mol Sci. 2014;15(6):10296-10333. doi:10.3390/ijms150610296Arthritis Foundation.How rheumatoid arthritis affects more than joints.Oweis AO, Alawneh KM, Alshelleh SA, Alnaimat F, Alawneh D, Zahran DJ.Renal dysfunction among rheumatoid arthritis patients: A retrospective cohort study.Ann Med Surg(Lond). 2020 Nov 4;60:280-284. doi:10.1016/j.amsu.2020.11.011Johns Hopkins Medicine.Glomerulonephritis.Joaquim AF, Appenzeller S.Neuropsychiatric manifestations in rheumatoid arthritis.Autoimmun Rev.2015;14(12):1116-22. doi:10.1016/j.autrev.2015.07.015Arthritis Foundation.RA and gastrointestinal problems.Johns Hopkins Medicine.Digestive disorders.National Heart, Lung, and Blood Institute.The respiratory system.Kim JW, Suh CH.Systemic manifestations and complications in patients with rheumatoid arthritis.J Clin Med. 2020;9(6):2008. doi:10.3390/jcm9062008Duarte A.Sjögren’s syndrome. American College of Rheumatology.Harrold LR, Shan Y, Rebello S, et al.Prevalence of Sjögren’s syndrome associated with rheumatoid arthritis in the USA: an observational study from the Corrona registry.Clin Rheumatol. 2020;39(6):1899-1905. doi:10.1007/s10067-020-05004-8Arthritis Foundation.6 Self-Care Tips for RAPeter WF, Swart NM, Meerhoff GA, Vliet Vlieland TPM.Clinical Practice Guideline for Physical Therapist Management of People With Rheumatoid Arthritis.Phys Ther. 2021 Aug 1;101(8):pzab127. doi:10.1093/ptj/pzab127
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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