Long term risk

The course and severity of arthritis and its forms are unpredictable. It is marked by period of exacerbation and remission. Some individuals have been known to recover from a first attack and never suffer a recurrence. For others, particularly those in whom the rheumatoid factor is found, the disease tends to be chronically progressive. The likelihood that the patient will enter a complete remission after 3 years of sustained disease activity is very slight. If it is not treated, there’s a tendency to relapse and to recur in a more severe form. Continued competent medical care is of the utmost importance for anyone who has arthritis. Even with careful management, approximately 10% of patients with rheumatoid arthritis progress to a crippling state of complete incapacity. Arthritis can result to its malignant state. The length of time between exacerbations varies greatly with individuals. Some evidence suggests that exacerbations can be triggered by mental stress such as worry or grief, by overexertion, and at times by physical trauma such as surgery.

SYSTEMIC AND ORGAN COMPLICATIONS

Arthritic granulomas – Subcutaneous nodules occur most commonly over pressure areas and tendon sheathes. They have also been encountered almost anywhere connective tissue is inflamed.

Pleuropulmonary lesions- They are chronic, diverse, and generally non life-threatening. They include chronic effusions, nodular pulmonary disease due to arthritic nodules, diffuse interstitial fibrosis.

Ocular manifestations - have occurred primarily in the sclera, iris, and ciliary body due to generalized inflammation and localized subcutaneous nodules. Major complications of scleritis occurred causing uveitis, cataracts, secondary glaucoma, and perforation.

Neuropathy – is usually caused by local or generalized inflammation and sometimes by localized nodules. Diffuse neuropathy is the most common neuromuscular manifestation of arthritis. Most patients complain of numbness or burning pain and have decreased reflexes. Generally, there are only minor motor and sensory changes with minimal residual problems. However, some persons develop rapid, generalized neuromuscular involvement which leads to severe sensorimotor neuropathy with paralysis. Their prognosis for life is poor.

Renal dysfunction - Renal damage may occur, especially if recurrent uric acid stones have been present in case of gouty arthritis.

Anemia- The pathogenesis is obscure, but there is general agreement that the degree of anemia is related to the amount of inflammation or to an iron deficiency usually caused by chronic blood loss from aspirin gastritis. Chronic active arthritis usually is associated a moderate decrease in hemoglobin, but the level is rarely low enough to cause symptoms per se.

Generalized Osteoporosis is not uncommon. The causes are probably multiple: (1) Excessive, generalized protein catabolism and poor nutrition, (2) loss of physical vigor and activity as the joint disease progresses, (3) in older people, the loss of the anabolic effects of androgens and estrogens, (4) the release of substances, such as prostaglandins, by the inflamed synovium that have been identified as calcium-releasing factors for bone, and (5) the inflammatory process, itself, within the joint. It is important to note that the degenerative process is aggravated by some medications such as corticosteroids. Most of the fractures that occur due to degenerative changes involve the collapse of the porotic dorsal and lumbar vertebrae which cause severe pain and disability.