Complications

Complication
Timeframe
Likelihood
long term
high

Long-term significant outcome of rheumatoid arthritis (RA) if not treated adequately. In a review of biological agents in patients with RA, almost all studies showed positive results with respect to work presenteeism.[190]

long term
high

Long-term significant outcome of rheumatoid arthritis if not treated adequately.

long term
high

Rheumatoid arthritis is a risk factor by itself, in addition to traditional cardiovascular risk factors. Patients with RA have more prevalent coronary artery disease, higher coronary calcium scores, more high risk plaques and multi-vessel disease compared with controls.[191]

long term
high

Untreated rheumatoid arthritis leads to, on average, 8- to 10-year shortening of life span.

long term
high

ILD is an increasingly recognised complication of rheumatoid arthritis and is associated with significant morbidity and mortality.[192]

Patients with RA-related ILD are at high risk of infection and drug toxicity, which, along with comorbidities, complicates further treatment decision-making.

long term
low

A complication of long-standing rheumatoid arthritis (RA). It is defined by the presence of 3 conditions: RA, splenomegaly, and an abnormally low white blood cell count.

It affects <1% of patients with RA.

Felty's syndrome

variable
medium

Rheumatoid arthritis can be associated with the development of CTS. Rates as high as 29% have been reported (but more typically around 10% to 20%). Presumably the main mechanism is due to a narrowing of the carpal tunnel from thickening of the wrist joint synovium and tendon sheaths.[188][189]

variable
low

Dose is adjusted or treatment discontinued.

variable
low

Treatment should be stopped while the infection is being treated. If serious, discontinuation of the TNF-alpha inhibitor should be considered. Repeated episodes should also lead to consideration of discontinuation.

This complication can occur at any time but is more common in the first 6 months after treatment is started.[185] One study showed that there is no increased risk of serious infection and malignancy among patients with early disease who have not previously been treated with disease-modifying antirheumatic drugs and/or methotrexate.[117]

variable
low

Treatment should be discontinued.

This complication can occur at any time but may be more common early in treatment course.[186][187] One study showed that there is no increased risk of serious infection and malignancy among patients with early disease who have not previously been treated with disease-modifying antirheumatic drugs and/or methotrexate.[117]

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