Complications

Complication
Timeframe
Likelihood
long term
high

Long-term significant outcome of rheumatoid arthritis (RA) if not treated adequately. In a review of biologic agents in patients with RA, almost all studies showed positive results with respect to work presenteeism.[201]

long term
high

Long-term significant outcome of rheumatoid arthritis (RA) 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 multivessel disease compared with controls.[202]

long term
high

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

long term
high

ILD is an increasingly recognized complication of rheumatoid arthritis (RA) and is associated with significant morbidity and mortality.[203]

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 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.[199][200]

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.[196] 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.[120]

variable
low

Treatment should be discontinued.

This complication can occur at any time but may be more common early in treatment course.[197][198] 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.[120]

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