9 Unusual Symptoms Linked to Rheumatoid Arthritis

RA inflammation affects more than joints. The signs and symptoms of RA and conditions related to it may be felt all over the body, including in the ears, eyes, skin, lungs, and heart. Below is a description of 9 unusual symptoms that may be related to your rheumatoid arthritis.

1. Hearing problems

Researchers have found that hearing loss and tinnitus (constant ringing, buzzing, or whistling in the ears) can be linked to rheumatoid arthritis. Hearing problems typically show up in older people who have had rheumatoid arthritis for many years.

Experts suggest many ways RA may contribute to hearing problems:

• Rheumatoid arthritis inflammation may damage the tiny joints in the ear. ¹ Emamifar A, Bjoerndal K, Hansen IM. Is Hearing Impairment Associated with Rheumatoid Arthritis? A Review. Open Rheumatol J. 2016;10:26-32. Published 2016 Mar 15. doi:10.2174/1874312901610010026
• A rheumatoid nodule can develop inside the ear. ¹ Emamifar A, Bjoerndal K, Hansen IM. Is Hearing Impairment Associated with Rheumatoid Arthritis? A Review. Open Rheumatol J. 2016;10:26-32. Published 2016 Mar 15. doi:10.2174/1874312901610010026
• Drugs that reduce RA symptoms, including aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) ² Huang C-M, Chen H-J, Huang P-H, et al. Retrospective cohort study on risk of hearing loss in patients with rheumatoid arthritis using claims data. BMJ Open 2018;8:e018134. doi:10.1136/ bmjopen-2017-018134 PMCID: PMC5780710 and hydroxychloroquine ³ Bortoli R, Santiago M. Chloroquine ototoxicity. Clin Rheumatol. 2007;26(11):1809-1810. doi:10.1007/s10067-007-0662-6 , may occasionally bring on tinnitus and/or hearing loss.
• Other disease processes may affect the auditory nerves or cochlear hair cells in the ear that are necessary for hearing. ¹ Emamifar A, Bjoerndal K, Hansen IM. Is Hearing Impairment Associated with Rheumatoid Arthritis? A Review. Open Rheumatol J. 2016;10:26-32. Published 2016 Mar 15. doi:10.2174/1874312901610010026

Some hearing problems are treatable—for example, stopping the use of NSAIDs may reverse symptoms—while others may be permanent. Even when changes to hearing are permanent, steps may be taken to stop or slow down future hearing loss.

2. Snoring

Research suggests a significant connection between rheumatoid arthritis and sleep apnea ⁴ Reading SR, Crowson CS, Rodeheffer RJ, Fitz-Gibbon PD, Maradit-Kremers H, Gabriel SE. Do rheumatoid arthritis patients have a higher risk for sleep apnea?. J Rheumatol. 2009;36(9):1869-1872. doi: 10.3899/jrheum.081335 ^{, 5} Shen TC, Hang LW, Liang SJ, et al. Risk of obstructive sleep apnea in patients with rheumatoid arthritis: a nationwide population-based retrospective cohort study. BMJ Open. 2016;6(11):e013151. Published 2016 Nov 28. doi: 10.1136/bmjopen-2016-013151 , which causes breathing to repeatedly stop and start during sleep. Symptoms include loud snoring and interruptions in breathing and/or gasping for breath while sleeping.

Sleep apnea can also cause headaches and contribute to chronic fatigue because the body takes in less oxygen at night.

Sleep apnea can be diagnosed and treated. Treatment typically includes using a continuous positive airway pressure (CPAP) machine or another treatment device to increase oxygen intake while sleeping.

3. Skin rash

When RA inflammation affects the blood vessels (Rheumatoid Vasculitis / Vasculitis), it can cause a variety of problems, including skin rashes. These rashes may appear as clusters of dark red or purple bumps, hives, or irregularly shaped raised pink patches on the skin. On darker skin, changes in skin color may be less noticeable.

Rashes related to vasculitis can occur anywhere but are most common on the lower legs. Sometimes these rashes are itchy, painful, or burning.

In addition, biologics medications used to treat RA increase the risk of rashes and other skin problems ⁶ Pasadyn SR, Knabel D, Fernandez AP, Warren CB. Cutaneous adverse effects of biologic medications. Cleve Clin J Med. 2020;87(5):288-299. 10.3949/ccjm.87a.19119 , such as skin infections.

If you have a persistent rash that has lasted for more than 2 weeks, is painful, or looks infected, it’s advisable to contact your physician. Medical treatment is recommended for any rash that is persistent, severe, or accompanies symptoms of vasculitis in other areas of the body, such as the lungs, heart, kidneys, or eyes.

4. Trouble breathing, chronic cough, or chest pains

The lungs are commonly affected by rheumatoid arthritis, especially if the RA is long-standing and has not been well-managed.

Shortness of breath accompanied by a chronic cough, fatigue, and/or weakness may be a sign of scarring caused by chronic inflammation of the lungs. Shortness of breath accompanied by fever and/or chest pain when breathing may be a sign of fluid build-up around the lungs (pleural effusion). Both lung scarring and pleural effusion can be serious conditions, and medical attention is recommended.

5. Sudden, temporary numbness in the fingers or toes

Rheumatoid arthritis increases the risk for Raynaud Syndrome, also known as Raynaud Phenomenon or Raynaud disease. This condition causes one or more fingers or toes to lose blood circulation. The affected area will feel numb and appear paler, white, or blueish. There is typically a distinct border between this area and normal-colored tissue.

Raynaud Syndrome can be triggered by cold exposure, emotions, and certain medications. ⁷ Filippone, Lisa M. MD Diagnosis: Raynaud Phenomenon, Emergency Medicine News: August 2004 - Vol 26 - Issue 8, p 30. Accessed August 10, 2021, https://journals.lww.com/em-news/Fulltext/2004/08000/Diagnosis__Raynaud_Phenomenon.19.aspx/a> An episode may last minutes or hours. A warm compress, bath, or shower may encourage blood flow. If symptoms do not resolve then medical intervention may be necessary to prevent tissue damage.

6. Gum disease

Rheumatoid arthritis is associated with gum inflammation (gingivitis) and gum disease (periodontitis). ⁸ Mercado FB, Marshall RI, Klestov AC, Bartold PM. Relationship between rheumatoid arthritis and periodontitis. J Periodontol. 2001 Jun;72(6):779-87. doi: 10.1902/jop.2001.72.6.779. PMID: 11453241/a>. ^{, 9} Bartold PM, Marshall RI, Haynes DR. Periodontitis and rheumatoid arthritis: a review. J Periodontol. 2005 Nov;76(11 Suppl):2066-74. doi: 10.1902/jop.2005.76.11-S.2066. PMID: 16277578. Both of these conditions are linked to worsening RA symptoms ¹⁰ Rodríguez-Lozano B, González-Febles J, Garnier-Rodríguez JL, Dadlani S, Bustabad-Reyes S, Sanz M, Sánchez-Alonso F, Sánchez-Piedra C, González-Dávila E, Díaz-González F. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study. Arthritis Res Ther. 2019 Jan 18;21(1):27. doi: 10.1186/s13075-019-1808-z. PMID: 30658685 and can lead to gum damage and tooth loss.

Regular dental checkups and good oral hygiene at home may help improve oral health as well as ease rheumatoid arthritis symptoms, such as joint tenderness and swelling. ¹¹ Sun J, Zheng Y, Bian X, Ge H, Wang J, Zhang Z. Non-surgical periodontal treatment improves rheumatoid arthritis disease activity: a meta-analysis. Clin Oral Investig. 2021 Jan 29. doi: 10.1007/s00784-021-03807-w. Epub ahead of print. PMID: 33515120 ^{, 12} Kaur S, Bright R, Proudman SM, Bartold PM. Does periodontal treatment influence clinical and biochemical measures for rheumatoid arthritis? A systematic review and meta-analysis. Semin Arthritis Rheum. 2014 Oct;44(2):113-22. doi: 10.1016/j.semarthrit.2014.04.009. Epub 2014 Apr 28. PMID: 24880982 ^{, 13} Ortiz P, Bissada NF, Palomo L, et al. Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors. J Periodontol. 2009;80(4):535-540. doi:10.1902/jop.2009.080447 PMID: 19335072

7. Increased fat-to-lean mass ratio

People who have RA tend to have a higher fat-to-lean mass ratio than people who do not have RA. ¹⁴ Turk SA, van Schaardenburg D, Boers M, et al. An unfavorable body composition is common in early arthritis patients: A case control study. PLoS One. 2018;13(3):e0193377. Published 2018 Mar 22. doi:10.1371/journal.pone.0193377 PMID: 29565986 ^{, 15} Book C, Karlsson MK, Nilsson JÅ, Akesson K, Jacobsson LT. Changes in body composition after 2 years with rheumatoid arthritis. Scand J Rheumatol. 2011;40(2):95-100. doi: 10.3109/03009742.2010.507215 This difference tends to hold true even for people whose weights are within normal range. Experts are not sure why.

Strengthening exercises can help counteract the loss of muscle. If applicable, losing excess weight may decrease rheumatoid arthritis disease activity and therefore reduce symptoms. ¹⁶ Alvarez-Nemegyei J, Buenfil-Rello FA, Pacheco-Pantoja EL. Association between body composition and disease activity in rheumatoid arthritis. A systematic review. Asociación entre composición corporal y actividad inflamatoria en artritis reumatoide. Una revisión sistemática. Reumatol Clin. 2016;12(4):190-195. doi:10.1016/j.reuma.2015.09.001 PMID: 26549160 The combination of building muscles and losing excess weight will support joint health and may reduce RA symptoms.

8. Red eyes

While nearly everyone experiences temporarily irritated, red eyes occasionally, eye redness that is recurring, persistent, and/or severe may be a sign of a medical condition related to RA. Eye conditions may be temporary or life-long and typically cause other symptoms, such as eye pain, sensitivity to light, watering, or irritation.

Signs and symptoms of eye problems, including any changes in vision, should be immediately reported to a health care practitioner.

9. Numbness or tingling

A damaged or pinched nerve can cause numbness and tingling in the hands, feet, or other areas of the body. Rheumatoid arthritis may contribute to nerve injury in a few ways:

• Swollen joint tissues cause a nerve to be pinched (for example, carpal tunnel syndrome can result from swollen joints in the wrist)
• Vasculitis related to RA affects blood flow and causes nerve damage
• Certain RA medications may also cause side effects of numbness and tingling sensations

While not necessarily painful, it’s best to report sensations of numbness and tingling to a physician. Addressing the cause may help prevent nerve problems from becoming worse or chronic.

New and unusual symptoms are not always related to rheumatoid arthritis. Contact your doctor to identify the possible cause of unfamiliar symptoms and discuss treatment strategies.

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