Rheumatism is an autoimmune disease that may have genetic and environmental triggers like smoking.
Typically, it manifests as an inflammatory response, hence it is not uncommon that virtually every organ system in the body may be involved.
Complications arising from Rheumatism
- Atherosclerosis
This could lead to the scarring of blood vessels that convey oxygen to the rest of the body – a condition known as Atherosclerosis, a common feature in diabetes and hypertension.
- Myocardial infarction
The consequence of this is a higher risk of heart attack or myocardial infarction.
- Endocarditis
The inflammatory process can affect just any part of the heart from the covering, known as pericarditis to the inner layer of the heart; in this case endocarditis.
- Fibroids
As a sequel to this, the heart valves may be damaged by the inflammatory process leading to scarring or fibroids.
- Stenosis
The consequence of this is that it may lead to narrowing of the valves channels of blood flow through the chambers of the heart, a condition known as stenosis.
- Heart failure
On the other hand, there may be a complete loss of function of the valves leading to ”incompetence” where the unidirectional flow of blood is compromised.
Ultimately, this leads to stress on the heart muscles and heart failure.
- Anemia
One of the commonest complications of rheumatism is the shortage of blood known as anemia.
This is caused by the production of warm antibodies in the body that destroy red blood cells in the body.
Ironically no structural changes are noticed on the red cells like what one sees in some hemolytic disorders like sickle cell anemia.
The second mechanism involved in this anemia is a result of poor absorption of iron and its engulfment by giant white blood cells known as macrophages.
This entire process is triggered by a substance known as HEP-CIDIN which is usually raised in chronic inflammatory conditions as is the case in rheumatoid arthritis.
Other important blood factors that may be affected if this inflammatory situation is not controlled are the blood dust.
They come into play in the control of bleeding and are known as platelets.
In rheumatoid arthritis, their number tends to increase in the blood; a phenomenon is known as Thrombocytosis and this could be problematic.
But due to relative anemia, challenging coagulation of blood in the vessels is not very common.
- Kidney problem
The kidney is another organ that may be adversely affected by the rheumatoid inflammatory process. The glomerulus is the filtration unit of the kidney.
This sponge looking alike structure has small vessels in close contact with the mesangium.
These mesangial cells have immune properties and also involved in phagocytosis, which basically is the engulfment of bacteria and other unwanted particles in the body.
- Renal Amyloidosis
During rheumatism, the blood vessels could become inflamed – a condition that is known as vasculitis.
At the same time, immune complexes from the mesangium can become deposited in the Bowman’s capsule and the glomerulus resulting in the so-called Renal Amyloidosis.
- Nephrotic syndrome
The consequences of this could be ultrafiltration challenges with proteins leaking into urine resulting in nephrotic syndrome.
The skin manifestation of rheumatoid arthritis is characteristic of the disease – a condition known as Rheumatoid Nodule, the initiation is largely unknown.
This basically has the makeup of a central core of scar tissue and dead cells.
Surrounding this are large white cells, macrophages, and scar tissue. These are all in keeping with features of chronic inflammation.
A cross-section of the nodule correlates with the features as seen in the bigger joints with rheumatism.
One good thing is that this bizarre feature of the disease does not occur in internal organs, which in any case have its own peculiar features.
- Pleurisy
For instance, in the lungs, there is scarring aptly described as fibrosis. This further makes it imperative that rheumatoid arthritis and smoking should never be bedfellows.
The symptoms in a rheumatoid lung could be all-embracing; starting from the inflammation of the pleural cavity, which is the outer covering of the lung known as Pleurisy.
- Effusion
This could lead to massive accumulation of fluid, known as Effusion, which in most instances would require surgical drainage.
There are also instances of nodule formation in the lungs tissue like you have in the skin but do not have the same cellular composition.
- Bronchiectasis
The most life-threatening is the condition where the small air passage known as bronchioles is narrowed or constricted as a result of inflammation and scarring.
This lesion is usually irreversible and could lead to a segmental collapse of the lungs with superinfection; a condition known as Bronchiectasis.
Rheumatic lung disease, in reality, can progress to any life-threatening condition from pulmonary hypertension, chronic obstructive airway disease to carcinoma of the lungs.
Not uncommonly, we would have severe nerve affectation in rheumatism.
Just like in diabetes, peripheral neuropathy could be a challenge with pains and loss of sensation.
Neuropathic foot ulcers that are common in diabetes are rarely seen in rheumatoid arthritis. But a very serious condition in extreme cases is the uncontrolled flexion (bending forward) of the neck.
This condition known as Subluxation is when two ends of a joint slide on each other.
This is a very common occurrence in the shoulder joint due to instability resulting from weak ligaments.
In the neck, it results from the Odontoid process of the second cervical bone getting eroded.
This, together with inflammation of the transverse ligament of the cervical spine that is attached to the skull could cause the vertebrae to slip.
This ultimately could lead to cord compression and paralysis if intervention is delayed.
Ironically, in spite of the liver being the engine room of metabolic activity in the body with its rich blood supply, rheumatoid inflammation of the liver or hepatitis is unheard of.
However, there is increased activity of liver cells or rather hepatocytes due to increased production of Cytokines.
Acute-phase proteins like C-reactive proteins involved in the complement system of the immune response are also increased in their production.
In spite of these intense biological activities, the liver is symptom-free.
It must always be remembered that as a rule, those with rheumatism are sick and the constitutional symptoms vary from fever, malaise, weakness, pains, and anemia.
Finally, just like any organ system that is subjected to stress, wear and tear, the lymph nodes are the harbinger of immunological response in the body.
It is not uncommon that in rheumatoid arthritis of long-standing nature that there may be neoplastic changes in the nodes giving rise to malignant Lymphoma. A little technical you might say.
