Rheumatoid Arthritis and Your Organs Dr Chandini Rao Consultant Rheumatologist

Overview Extra-articular manifestations of RA Comorbidities What can we do to prevent organ damage? Quiz….

Organ Involvement in RA Is not inevitable Is much less common than it used to be Needs to be looked for Can be prevented Control of inflammation Management of associated risk factors

Organ Involvement Extra-articular features: Comorbidities: Effects of RA outside the joints Comorbidities: Separate conditions that are seen more commonly in people with RA

Extra-articular Features of RA - General Fatigue Loss of appetite / weight loss Fever Depression Due to raised levels of inflammatory chemicals in the bloodstream

Extra-articular Features of RA - Skin

Extra-articular Features of RA - Eyes Dry eyes (secondary Sjogren’s Syndrome) Inflammation: Scleritis Episcleritis Uveitis Corneal scarring (Cataracts) (Glaucoma)

Extra-articular Features of RA - Lungs Inflammation of lung tissue – “interstitial lung disease” Fluid around the lung – “pleural effusion” Rheumatoid nodules within the lung

Extra-articular Features of RA - Heart Inflammation of heart lining – “pericarditis” Inflammation of heart muscle – “myocarditis” Inflammation of blood vessels in the heart – “coronary vasculitis”

Extra-articular Features of RA – Nervous System Inflammation / damage to nerves – “neuropathy” Inflammation / damage to spinal cord – “myelopathy”

Extra-articular Features of RA - Kidneys Inflammation of kidney – “nephritis” Prolonged systemic inflammation  amyloidosis

Extra-articular Features of RA - Blood Low red blood cells – “anaemia” Blood loss Medication Autoimmune Low white blood cells /platelets

Extra-articular Features of RA – Felty’s Syndrome

Comorbidities in Rheumatoid Arthritis - Osteoporosis Reduced bone density / weaker bone structure Increased risk of low-trauma fracture Risk factors: Prolonged high disease activity Immobility Steroids Smoking

Comorbidities in Rheumatoid Arthritis – Cardiovascular Disease Increased risk of heart attacks and strokes Risk Factors: Prolonged high disease activity Immobility / lack of exercise Smoking Steroids

Comorbidities in Rheumatoid Arthritis – Mental Health Increased risk of anxiety and depression: Diagnosis of a long term condition Concerns about future Concerns about ability to work Personal relationships High levels of disease activity Medications

Prevention 1 Early diagnosis and treatment of RA Early Arthritis Clinics GP awareness Public awareness

Prevention 2 Tight control of disease activity Regular assessments / treatment escalation DMARDs Biologics

Prevention 3 Annual Review Clinics Assessment of disease activity (DAS) Screening for complications FRAX questionnaire for osteoporosis QRISK2 calculation for heart disease risk PHQ-9 questionnaire for anxiety and depression

Prevention 4 Lifestyle modification Smoking cessation Weight management Healthy diet Regular exercise

Thank You!