From the Guidelines
Untreated rheumatoid arthritis (RA) leads to several serious long-term complications that significantly impact quality of life and longevity, including joint destruction, cardiovascular disease, lung involvement, osteoporosis, and psychological impacts, emphasizing the need for early treatment with disease-modifying antirheumatic drugs (DMARDs) to prevent or minimize these complications.
Long-term Complications of Untreated RA
The complications of untreated RA are multifaceted and can affect various aspects of a patient's life. Some of the key complications include:
- Joint destruction: Progressive erosion of cartilage and bone causing permanent deformities, loss of function, and disability, particularly in the hands, wrists, and feet 1.
- Cardiovascular disease: Systemic inflammation can lead to accelerated atherosclerosis, increasing the risk of heart attacks and strokes 1.
- Lung involvement: Interstitial lung disease, pleural effusions, or pulmonary nodules can cause breathing difficulties and reduced lung function 1.
- Osteoporosis: Chronic inflammation, immobility, and sometimes corticosteroid use can increase fracture risk 1.
- Psychological impacts: Depression and anxiety are common due to chronic pain and functional limitations 1.
Importance of Early Treatment
Early treatment with DMARDs like methotrexate, biologics such as TNF inhibitors, or JAK inhibitors can prevent or minimize these complications by controlling inflammation and halting disease progression before irreversible damage occurs 1. The goal of treatment is to achieve remission or low disease activity, improving patient outcomes and quality of life 1.
Key Considerations
When managing RA, it is essential to consider the individual patient's needs, preferences, and comorbidities, and to involve them in the decision-making process 1. Regular monitoring and adjustments to treatment are crucial to ensure optimal disease control and minimize adverse effects 1. By prioritizing early treatment and a patient-centered approach, healthcare providers can significantly improve the long-term outcomes for individuals with RA.
From the Research
Long-term Complications of Untreated Rheumatoid Arthritis (RA)
- Untreated RA can lead to substantial morbidity, reduced life expectancy, and poor quality of life 2
- Seropositive RA is associated with worse prognoses and increased risk of extra-articular manifestations, including:
- Cardiovascular diseases
- Lung disorders
- Malignancies
- The development of disease-modifying antirheumatic drugs has paved the way for improving disease outcomes and reducing morbidity and complications related to disease 2, 3
Disease Progression and Treatment
- Early and continuous use of DMARDs is necessary to slow joint damage and improve long-term outcomes 3
- However, long-term treatment with these drugs is frequently limited by loss of response and/or onset of serious adverse events 3
- Methotrexate is the most commonly used DMARD, with almost 90% of patients with recent onset RA taking it as the anchor drug 4
Risks and Uncertainties of Treatment
- All long-term treatments for RA carry a risk of severe adverse effects, and their chronic effects are poorly documented 5
- There is no firm evidence that long-term treatments reduce the risk of serious disability or death 5
- The use of certain medications, such as methotrexate, hydroxychloroquine, and sulfasalazine, carries risks of adverse effects, including hepatic cirrhosis, pulmonary fibrosis, and haematological disorders 5