Important consequences of rheumatoid arthritis

Important consequences of RA are more likely to occur in longstanding erosive or poorly controlled disease. These are becoming less frequent with earlier use of immunomodulatory drugs, but may include:

• irreversible joint damage, resultant deformity and functional impairment
• carpal tunnel syndrome—associated with inflammatory synovitis of the wrist
• atlanto-axial instability—rare; associated with RA involving the cervical spine, posing a risk of cervical myelopathy due to compression of the odontoid process on the upper spinal cord. Any patient with RA and features suggestive of cervical myelopathy should be referred urgently to a neurosurgeon.

Depression is common in people with RA, and may be associated with chronic pain, functional limitation, sleep disturbance and fatigue.

Many drugs used in the treatment of RA have potential adverse effects and interactions, for example long-term systemic corticosteroid therapy, and various disease-modifying antirheumatic drugs (DMARDs); see Principles of immunomodulatory drug use for more details.