How Arthritis Impacts Your Overall Health
Arthritis is a chronic inflammatory condition primarily characterized by joint swelling, stiffness and pain. It can impact multiple body parts and pervade all aspects of life, from daily activities to dating, and is a leading cause of disability worldwide. About 24 percent of adults in the United States, or 58.5 million people, have arthritis, according to the Centers for Disease Control and Prevention (CDC).
There are more than 100 types of arthritis and related diseases, each of which has distinct symptoms and effects. The types are grouped into osteoarthritis (OA) and inflammatory arthritis.
Osteoarthritis, known as "wear and tear" arthritis, is the most prevalent type and occurs when the cartilage and other tissues between joints degrade.
"This is similar to what we see with the hinges of an iron gate in an outdoor garden: The hinge will work well for many years but will tend to wear out and become less functional over time," said Benjamin Service, M.D., an orthopedic surgeon at Orlando Health in Florida.
The second-most common form, rheumatoid arthritis (RA), is an autoimmune condition wherein the immune system mistakes bodily tissues as harmful invaders and unleashes an attack, leading to inflammation and damage. Although RA originates in joints, it can extend to multiple body parts, such as the heart, lungs, nerves and skin.
Other common types of inflammatory arthritis include psoriatic arthritis, gout and ankylosing spondylitis.
The specific effects and symptoms differ from one type of arthritis to another, but all can substantially impact a person's overall health and well-being, including mental, sexual and reproductive health. Conditions and circumstances such as depression, menstruation, menopause and pregnancy may exacerbate or alleviate arthritis symptoms. Although complications can occur, most forms of arthritis are highly treatable, particularly with early intervention.
Arthritis and overall health
Different forms and stages of arthritis can impact overall health in different ways. Most forms, particularly in the advanced stages, cause chronic pain and limited mobility, which can contribute to issues such as chronic fatigue, insomnia and an increased risk of falls and injuries.
"Arthritis is not just a limiting condition but a deteriorating condition of overall health associated with many comorbidities, such as obesity, diabetes and heart disease," said Dmitriy Dvoskin, M.D., a physician at Pain Management NYC in New York City.
In part, this deterioration occurs because of arthritis' impact on mobility, he explained, which can make exercise or even everyday activities challenging. Although it may be difficult, regular physical activity and maintaining a healthy weight can improve arthritis symptoms and preserve overall health. Low-impact and modified exercises, such as water aerobics, can make movement less painful. Medications and an anti-inflammatory diet may help to assuage symptoms as well.
Hormones, pregnancy and arthritis
Hormonal changes can alleviate or exacerbate arthritis symptoms, said Caroline H. Siegel, M.D., a rheumatology fellow at the Hospital for Special Surgery in New York City. Although these effects apply to people of all sexes and genders, people assigned female at birth (AFAB) are most likely to be affected.
AFAB people are about twice as likely to develop rheumatoid arthritis and far more susceptible to autoimmunity in general. Although the cause of autoimmunity is unknown, some experts believe genetics and the hormone estrogen play roles. AFAB folks also experience more extreme and frequent hormone fluctuations, particularly during menstruation, pregnancy and menopause. During these periods, levels of estrogen—a hormone that influences pain perception and immunity—fluctuate significantly. These events can contribute to other physical and mental health implications that exacerbate or alleviate arthritis symptoms.
Many AFAB people experience flare-ups—or worsening symptoms—of inflammatory arthritis before and during their period, according to the Arthritis Foundation. During pregnancy, weight gain, water retention and other physical alterations can put pressure on the joints, particularly the hips, knees and ankles, which may worsen arthritis symptoms, too.
However, because levels of corticosteroids, estrogen and progesterone increase during pregnancy, Siegel noted about half of birthing people experience improvement or remission in their arthritis. Postpartum flare-ups are extremely common. Arthritis symptoms also tend to worsen during and after menopause, again because of changing hormone levels.
There's some indication people with rheumatoid arthritis have lower testosterone levels than people without, though the reason is unknown, Siegel noted.
"Different studies have found that postmenopausal women and men with lower testosterone levels may have an increased risk of a specific subtype of RA, known as 'seronegative' RA because it is defined by the absence of certain autoantibodies seen in typical, or 'seropositive,' RA," she explained. "Overall, there is substantial scientific evidence supporting the general idea that sex hormones play a role in the development and evolution of RA, but neither their specific role nor the underlying reasons for these associations are fully understood."
Mental health and arthritis
Arthritis can notably affect mental health, causing feelings of emotional imbalance, irritability, frustration, anxiety, apprehension and depression, according to Michael T. Mongno, M.Sc., M.F.T., a psychotherapist at Present Centered Therapies in New York City.
The emotional impact can be particularly marked when a person's arthritis inhibits their mobility and ability to engage with life. This can produce a vicious cycle, which exacerbates depression and causes other adverse mental health effects. There's also evidence insomnia and physical pain—common symptoms of arthritis—are associated with depression.
"Our overall health and well-being are, in large part, a product of how we feel physically," Mongno said. "Pain is an alert in the brain that informs our thoughts and emotions, and how we feel within and about ourselves. We reflexively move away from feeling pain in an attempt to restore the peace and balance within ourselves. The ongoing challenge of doing that can often be exhausting or depressing, and it's easy to begin a slow resignation from life and the opportunities still in store for us."
People with chronic conditions, including arthritis, are more likely than the average person to experience depression. With inflammatory arthritis, specifically, widespread inflammation may be part of the reason, Siegel said.
"The high rate of depression in RA may, in part, be related to living with pain, fatigue and the uncertainty that accompanies chronic illness," Siegel continued. "The association may be bidirectional; chronic inflammation itself may be a risk factor for developing depression. Studies have found a correlation between depression and active disease in RA, which may, in part, be explained by the fact that depression makes it more difficult to keep up with medical treatment."
Arthritis and sexual health
Siegel and Mongno both noted that sexual health is imperative to overall health and well-being, and can help regulate the nervous system, promote stress reduction, stimulate endorphin release and improve mood.
Unfortunately, people with arthritis encounter problems with sexual and reproductive health due to the disease itself, physical and psychiatric comorbidities, and the side effects of medications used to treat the condition, Siegel explained.
For instance, joint pain and swelling, which occur with all types of arthritis, can cause physical limitations and sexual dysfunction. Physical challenges can be particularly noticeable if arthritis affects the hips or knees. Furthermore, chronic fatigue, depression and anxiety—all common comorbidities—can diminish libido and contribute to erectile dysfunction (ED).
Anti-inflammatory and pain relief medications, combined with strategic positioning, can make sex more accessible and enjoyable, as can managing psychiatric conditions through therapy, medication and lifestyle changes.
With inflammatory arthritis, medications that suppress the immune system could slightly increase the risk of HPV-associated cervical dysplasia and cervical cancer, Siegel said, warranting more frequent Pap smears. Certain medications can cause complications during pregnancy.
"Some common RA medications, including methotrexate and leflunomide, are teratogenic, meaning they can be toxic to a developing embryo or fetus," she said. "For women taking these or other teratogenic medications, it is important that they use effective contraception. For women with RA who are planning for pregnancy, other medications must be used as these are not safe options, although they may be very effective for controlling arthritis."
Complications and related conditions
Some forms of arthritis are thought to arise from preexisting conditions. Psoriatic arthritis, for instance, affects people with psoriasis, and about 95 percent of people with lupus have arthritis, according to Johns Hopkins Medicine. In addition, people with arthritis are more susceptible to various conditions.
"Having [rheumatoid arthritis] significantly increases one's risk of heart disease," Siegel said. "It is thought that chronic inflammation contributes to the development of atherosclerosis."
People with arthritis are more likely to develop diabetes or obesity as well, she added. In people with inflammatory arthritis, this is because steroids commonly used to treat the disease can lead to or worsen weight gain and diabetes. Additionally, arthritis of all types can be painful and debilitating, potentially limiting physical activity and other healthy behaviors.
Research indicates rheumatoid arthritis is associated with a higher risk of sleep apnea, blood clots, inflammatory bowel disease (IBD), lymphatic system cancers and RA-related lung disease.
Service noted that physical changes in the joints of people with arthritis can increase the risk of additional problems. For instance, people with arthritis in the hips or knees may be more susceptible to falls due to decreased flexibility, mobility and strength.
"Taking too many medications, such as anti-inflammatories, can also lead to issues, including gastritis, ulcers and kidney damage," he added.
Arthritis can contribute to various complications, too, according to both Siegel and Service. If the joint inflammation is uncontrolled, it can lead to permanent damage, disfigurement and disability. Inflammatory arthritis, including rheumatoid arthritis, can affect multiple body systems. Most severe complications can be minimized or prevented with medical intervention.
"Although RA is defined by joint pain and swelling, it is a systemic autoimmune disease, meaning the inflammation has effects throughout the body, not just in the joints," Siegel explained. "Some people with RA develop lung disease, eye disease and skin vasculitis, which are due to the underlying inflammation throughout the body. Long-standing inflammation can also lead to collateral damage, as is the case with the development of heart disease. Individuals with RA are also at increased risk of developing low bone density and osteoporosis due to the inflammation itself as well as exposure to steroids used to treat the inflammation."
