Rheumatoid Arthritis: Secondary Diseases

The following are the most important diseases or complications that may be contributed to by rheumatoid arthritis:

Respiratory system (J00-J99)

Eyes and eye appendages (H00-H59).

  • Episcleritis – inflammation of connective tissue layers on the sclera (0.17-3% of cases).
  • Keratoconjunctivitis sicca (KCS) – inflammation of the conjunctiva associated with decreased tear secretion and keratitis (approximately 15-28% of cases).
  • Scleritis – inflammation of the sclera (0.6-6% of cases).

Blood, blood-forming organs – immune system (D50-D90).

  • Anemia (anemia)
  • Lymphoproliferative syndrome – disease associated with lymphadenopathy (disease of the lymph nodes) and lymphocytosis (increase in lymphocytes) (06.-6% of cases).

Endocrine, nutritional and metabolic diseases (E00-E90).

Skin and subcutaneous (L00-L99).

Cardiovascular system (I00-I99)

  • Atherosclerosis (arteriosclerosis, hardening of the arteries).
  • Cardiac vitiation (valvular heart disease):
    • Aortic regurgitation: odds ratio (OR) 1.7
    • Aortic stenosis: OR 5.2
    • Mitral regurgitation: OR 3.4
    • Mitral valve prolapse: OR 2.2
    • Tricuspid regurgitation: OR 5.3
  • Cardiovascular sequelae
    • Apoplexy (stroke) – three times more likely to have atherosclerotic plaques in carotids than healthy individuals
    • Heart failure, non-ischemic (cardiac insufficiency not due to reduced blood flow to the heart muscle)
    • Hypertension (high blood pressure)
    • Coronary artery disease (CAD; coronary artery disease).
    • Myocardial infarction (heart attack) twice as common as in the normal population.
      • Survival probability six years after myocardial infarction in RA sufferers between 50 and 60 percent, but in non-rheumatics between 70 and 80 percent
      • Mortality rate (death rate) 30 days after infarction is 18% in RA sufferers and 11% in patients without RA
      • Under anti-TNF therapy statistically significant 39% lower risk of myocardial infarction.
    • QT prolongation (cumulative incidence: 48%).
    • Venous thromboembolism (VTE), increased threefold.
    • Atrial fibrillation (VHF) OR 1.41 → risk of apoplexy (stroke) ↑
  • Pericardial effusion (pericardial effusion) OR 10.7
  • Pericarditis (inflammation of the pericardium)

Infectious and parasitic diseases (A00-B99).

  • Herpes zoster (shingles)
  • Sepsis (blood poisoning)

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

  • Primary biliary cholangitis (PBC, synonyms: nonpurulent destructive cholangitis; formerly primary biliary cirrhosis) – relatively rare autoimmune disease of the liver (affects women in about 90% of cases); begins primarily biliary, i.e., at the intrahepatic and extrahepatic (“inside and outside the liver”) bile ducts, which are destroyed by inflammation (= chronic nonpurulent destructive cholangitis).In the longer course, the inflammation spreads to the entire liver tissue and eventually leads to scarring and even cirrhosis; detection of antimitochondrial antibodies (AMA); PBC is frequently associated with autoimmune diseases (autoimmune thyroiditis, polymyositis, systemic lupus erythematosus (SLE), progressive systemic sclerosis, rheumatoid arthritis); Associated with ulcerative colitis (inflammatory bowel disease) in 80% of cases; long-term risk of cholangiocellular carcinoma (CCC; bile duct carcinoma, bile duct cancer) is 7-15%.

Mouth, esophagus (food pipe), stomach, and intestine (K00-K67; K90-K93).

  • Gastrointestinal ulcers – ulcers of the digestive tract especially as a side effect of therapeutically used drugs.
  • Periodontitis – inflammation of the periodontium (periodontium).

Musculoskeletal system and connective tissue (M00-M99).

  • Atlanto-axial subluxation – subluxation (incomplete dislocation) of the joint between the first cervical vertebra (atlas) and the second cervical vertebra (axis) due to loosening of the lig. transversum and arrosion (“destruction of the bone”) of the dens axis (tooth of the axis), which can lead to compression of the cervical (“belonging to the neck“) spinal cord; preventive regular X-ray examination of the cervical spine or magnetic resonance imaging (MRI).
  • Movement and occupational disability due to the severe joint damage or destruction.
  • Felty syndrome – Severe course of rheumatoid arthritis, almost always rheumatoid factor-positive, occurring mainly in men between the ages of 20 and 40. Associated with hepatosplenomegaly (enlargement of the liver and spleen), leukocytopenia (decrease in the number of white blood cells/leukocytes) and thrombocytopenia (decrease in the number of platelets/platelets). Felty syndrome usually occurs only after a prolonged course of chronic polyarthritis
  • Joint deformities
  • Muscular atrophy (regression of the musculature) with resulting weakness:
    • Sunken interdigital spaces (due to atrophy of the Mm. interossei).
    • Thumb pad atrophy
  • Osteoporosis (bone loss) (about 40-50% of patients in postmenopause).
  • Rheumatoid arthritis of the shoulder (50-80% of patients with rheumatoid arthritis); increasingly doing so, performance deficits of the rotator cuff (group of four muscles and their tendons that form the roof of the shoulder joint).
  • Sjögren’s syndrome (group of sicca syndromes) – autoimmune disease from the group of collagenoses, which leads to a chronic inflammatory disease of the exocrine glands, most often the salivary and lacrimal glands; typical sequelae or complications of sicca syndrome are:
    • Keratoconjunctivitis sicca (dry eye syndrome) due to lack of wetting of the cornea and conjunctiva with tear fluid.
    • Increased susceptibility to caries due to xerostomia (dry mouth) due to reduced salivary secretion.
    • Rhinitis sicca (dry nasal mucous membranes), hoarseness and chronic cough irritation and impaired sexual function due to disruption of mucous gland production of the respiratory tract and genital organs.
  • Ulnar deviation (splaying of the fingers towards the outside of the hand) of the metacarpophalangeal joints due to subluxations (incomplete dislocation of a joint, with the joint head still partially in the socket) of the carpal joints

Neoplasms – tumor diseases (C00-D48).

  • Lymphomas – malignant tumors originating from the lymphatic system.

Psyche – nervous system (F00-F99; G00-G99).

Symptoms and abnormal clinical and laboratory parameters not elsewhere classified (R00-R99).

  • Cachexia (rheumatoid cachexia; emaciation, very severe emaciation).
  • Tendency to fall

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99)

  • Renal insufficiency (kidney weakness).

Prognostic factors