What Are the Risks of Untreated Rheumatoid Arthritis?

Rheumatoid arthritis (RA) causes chronic inflammation in the lining of the joints, especially in the hands and fingers. Because RA is a progressive condition, it will get worse with time. And left untreated, it can cause severe damage to joints, lead to disability, and harm major organs.

While staying on top of your RA treatment may seem inconvenient at times, it is worth it, especially long-term, because not doing so could potentially put your quality of life at risk. Untreated RA can also put you at risk for some serious life-threatening problems.

Here is what you need to know about the short-term and long-term dangers of untreated RA, and what you can do to give yourself the best chance of living well with this chronic condition.

Short-Term Consequences

Two of the most common short-term consequences of RA are disease flare-ups and infections. Fortunately, you can reduce the risk by taking your medications as prescribed and following your healthcare provider’s disease-management plan. Nonetheless, both can still lead to serious and life-threatening problems.

Flare-Ups

A disease flare-up—a period of high disease activity and severe symptoms—can leave you in pain and feeling run-down from general malaise, fatigue, and even fever. RA flares can be very painful.

They can interrupt your life for days and weeks once they start. And they can be severe enough to interfere with your job, caring for your family, and daily tasks like getting dressed, driving, or preparing a meal.

Persistent and frequent disease flare-ups can lead to damage to joint and muscle tissues. Tissue damage can cause long-lasting and severe pain, affect balance, and lead to joint deformity. Ongoing inflammation can also cause problems in the lungs, heart, and eyes.

Infection

Untreated RA increases your risk for all types of infections­—respiratory, bacterial, viruses, and more. Observational RA studies show a risk for infection in people with RA that is twice that of people who don't have RA.

Infection risk applies even if you are successfully managing your disease, and untreated RA puts you at even greater infection risk. In RA, your immune system is too busy attacking the joints and other tissues, so it is not protecting you against infection. And the more severe your RA is, the higher your risk for infection.

The medications you take to treat RA can also increase your infection risk, because they suppress the immune system, which means your immune system cannot protect you as well as it should. Corticosteroids seem to pose the biggest risk, according to a study reported in 2016 by the journal PLoS Medicine.

This large study found the risk for infection was two-to six-fold higher in people taking oral corticosteroids compared to others of the same age, gender, and underlying disease who did not use corticosteroids. Researchers noted the extent of the risk was dependent on the dose and duration of the steroid being used.

Conventional disease-modifying anti-rheumatic drugs, such as methotrexate and leflunomide, can also increase your risk. Biologic drug therapies, like Humira (adalimumab) and Actemra (tocilizumab), also come with higher infection risk, especially for respiratory, skin, and soft-tissue infections.

Long-Term Consequences

If left untreated for long periods, RA will not only affect your quality of life, but it can also put your life in serious danger. Long-term, unmanaged inflammation can lead to disability and joint disfigurement, eye complications, skin symptoms, neck and spine problems, heart disease, blood vessel disease, blood cell problems, lung issues, osteoporosis, depression, and anxiety.

Disability and Joint Disfigurement

With RA, the body’s immune system is attacking the synovium—the lining of your joints­. This continued attack will lead to cartilage and bone damage. If RA is left untreated, chronic joint inflammation will cause permanent joint damage and deformity.

RA inflammation also affects the tissues that surround your joints, including the muscles, tendons, and ligaments responsible for stabilizing joints. This ongoing attack on these tissues eventually weakens them to the extent that they can no longer support your joints, and there is a loss of function and disability.

A study reported in 2019 in the medical journal Mayo Clinic Proceedings assessed the trends in the functional disability of people with RA versus those without the condition. This was done through self-report questionnaires regarding activities of daily living.

The researchers found that people with RA had a 15% higher rate of functional disability compared to people without RA in most age groups. The researchers concluded that because people with RA—especially those who were rheumatoid factor and/or cyclic citrullinated peptide positive—were already at a disadvantage, additional care was needed to improve their functional outcomes. 

Managing and treating RA is the best way to prevent disability and joint deformity. Successfully treating RA will require prescription and non-prescription medications, lifestyle therapies (like diet and exercise), and seeing your healthcare provider regularly.

Eye Problems

The same inflammation that attacks your joints can also affect your eyes. Any part of the eye can be affected by RA, but most people with RA experience problems in the front part of the eye.

RA inflammation of the sclera (white part of the eye) can result in eye dryness, redness, and pain. RA also affects the uvea, the layer between the retina and the white of the eye, leading to pain, redness, blurred vision, and light sensitivity.

If you have RA and experience eye inflammation, vision changes, or other eye problems, contact an ophthalmologist for an evaluation. Early diagnosis and treatment of eye problems can prevent vision loss and serious eye problems.

Having RA also puts you at risk for a condition called Sjogren’s syndrome, where the immune system attacks the glands that make tears. It will cause eyes to feel dry and gritty.

Without treatment, the eyes can become infected, or you could develop scarring of the conjunctiva (membrane covering the eye) or the cornea (the transparent front part of the eye covering the iris, pupil, and anterior chamber). Sjogren’s syndrome can also cause dry skin, dry cough, and vaginal dryness.

Skin Symptoms

The same immune response that inflames your joints can also affect your skin. Rashes, blisters, and nodules (lumps of tissue under the skin) are common in untreated RA.

Some RA medications can make you more likely to bruise, because they thin your skin and interfere with blood clotting. Other medications used to treat RA can make the skin more sensitive to the sun, leading to redness, itching, pain, tiny blisters, or hives on the skin.

Neck, Back, and Spine Problems

While RA is more common in other joints, it can also affect the spine, particularly in the neck. RA that affects the cervical spine (the neck) is not osteoarthritis—what's called wear-and-tear arthritis. Instead, it is what healthcare providers consider to be inflammatory arthritis.

With RA neck pain, you may experience pain even when those joints aren’t being used. 

Other symptoms you may experience when RA affects your spine include:

• Pain at the base of the skull
• Tenderness in the affected areas of the spine
• Loss of flexibility in affected areas of the spine
• Crepitus—a crunching feeling with movement; this is most noticeable in the neck, but it may also be felt in the low back
• Headaches
• Pain that radiates into one or both arms if the cervical spinal nerve is inflamed
• Pain radiating into one or both legs if the lumbar nerve is inflamed
• Changes to the way you walk, indicating pressure on the spinal cord
• Numbness, weakness, or tingling in the arms or legs
• Bowel or bladder problems like loss of bladder or bowel control

If you experience signs of bowel or bladder dysfunction or changes to your ability to walk or move, seek immediate medical attention. These are serious medical symptoms and need to be addressed quickly.

Heart Disease

Untreated RA increases the risk of heart disease. This is because the same inflammation that affects your joints also affects your heart.

According to a study reported in 2020 in the journal RMD Open, RA is associated with an increased risk of major adverse cardiovascular events. Such events include myocardial infarction (heart attack), stroke, and heart failure, among others.

In the RMD Open study, researchers looked at the risk for these events and early death in people with RA who had been referred for cardiac computerized tomography (CT) scans after complaints of chest pain.

They found a trend of cardiovascular disease events and outcomes in people with RA who had severe disease and/or were seropositive even after appropriate RA diagnosis and treatment.

Your risk is even higher for cardiovascular disease related to RA if you like additional risk factors, like high blood pressure, high cholesterol, smoking, diabetes, and a mostly sedentary (not active) lifestyle. And advanced or untreated RA further increases those odds.

Blood Vessel Disease

When blood vessels are inflamed, they weaken and thicken. Rheumatoid vasculitis can lead to blood vessel damage, reduced blood flow to organs, and, eventually, organ damage. It can affect both small and medium-sized blood vessels and may involve multiple organs—the skin, nerves, eyes, heart, lungs, and more.

Fortunately, thanks to better, more advanced treatment options for RA, vasculitis has become an extremely rare complication. However, it is common in long-standing, severe, and untreated or undertreated RA.

Blood Diseases

RA and some of the medications used to treat it can make it harder for your body to produce the right amount of healthy blood cells or blood platelets. This includes conditions like anemia, thrombocytosis, and Felty syndrome.

Anemia means you don’t have enough healthy red blood cells to carry oxygen through your body. Symptoms of anemia include fatigue, rapid heartbeat, shortness of breath, dizziness, weakness, headaches, leg cramps, and sleep problems.

Thrombocytosis occurs when inflammation leads to high amounts of platelets in the blood. Whether this contributes to increased risk of blood clots, strokes, and heart attacks in people with active rheumatoid arthritis is unknown.

Felty syndrome causes leukopenia (reduced white blood cell counts) and an enlarged spleen. It can increase your risk of serious infections and some types of cancers.

Lung Problems

Lung involvement can affect people with RA. This includes conditions like pleurisy, rheumatoid lung nodules, interstitial lung disease, and pulmonary hypertension.

RA can cause lung inflammation that leads to pleurisy, a condition affecting the pleura—the two thin layers that line the outside of the lungs and the inside of the chest wall. Pleurisy causes pain that gets worse with breathing.

Rheumatoid lung nodules can form on your lungs. Often, they are harmless, but other times, they can lead to a collapsed lung, an infection, or pleural effusion­—a buildup of fluid in the lining of the lungs and chest cavity.

RA is also known for causing interstitial lung disease (lung scarring) and pulmonary hypertension­—a type of high blood pressure that damages the arteries of the lung and heart.

Osteoporosis

People with RA have an increased risk for osteoporosis, a bone-thinning condition. The risk for osteoporosis is highest in women with RA.

Causes for increased bone loss leading to osteoporosis in people with RA include inflammation, inactivity, and corticosteroid use.

Depression and Anxiety

Depression and anxiety are the two most common mental illnesses associated with RA. A study reported in 2017 in the British Journal of General Practice found that the rate of depression in people with RA is around 39%, while the rate for anxiety is 20%.

While depression and anxiety don’t cause the physical symptoms of RA, they do make it harder to manage RA.

Early Death

Untreated RA increases your risk of dying early. According to a study reported in 2015 in the journal Arthritis Care and Research, people with RA have a significantly elevated risk for early death. The risk for early death is linked to disease complications and cardiovascular problems.

Protecting Yourself From RA Dangers

There are a number of highly effective treatments that can prevent joint damage, preserve function and mobility, reduce disease progression, and keep you enjoying a good quality of life with and despite RA.

Your rheumatologist will likely have you on a disease-modifying anti-rheumatic drug, or DMARD, like methotrexate, hydroxychloroquine, or sulfasalazine. DMARDs are effective in slowing down or stopping disease activity.

The American College of Rheumatology's (ACR) updated 2021 guidelines recommend treating newly diagnosed patients with moderate to severe RA with methotrexate alone as the first line of treatment. If RA symptoms don't improve enough on methotrexate alone, another therapy may be added.

Hydroxychloroquine is preferred for mild RA.

Glucocorticoids are sometimes prescribed to help alleviate pain and inflammation as a DMARD takes time to start working. The ACR guidelines recommend using the lowest effective dose for the shortest duration possible and discourage more than three months of glucocorticoid use when starting a conventional DMARD.  

Your rheumatologist may also recommend over-the-counter pain relievers to manage pain and inflammation, regular exercise, and physical therapy. You should also make healthy lifestyle choices like not smoking or overindulging in alcohol, maintaining a healthy body weight, and following a well-balanced, nutritious diet.

Give yourself time to respond to a new therapy and let your healthcare provider know if you have any problems with treatments like side effects or if a medication doesn’t seem to be working. It might take time to fight the right medicines to treat RA, but it is important to stick with your treatment plan if you want to gain control of RA and your life.

A Word From Verywell

RA is a chronic, life-long disease requiring a long-term commitment to treatment and disease management. Find a rheumatologist you can feel comfortable working with and can be open and honest with about your healthcare concerns.

If you have questions or are concerned about any part of your treatment plan, reach out to your healthcare provider to discuss them. When you keep the lines of communication open, you can help ensure successful treatment outcomes and a better quality of life with RA.