When people think of rheumatoid arthritis (RA), they often picture somebody with a few aches and pains... no big deal. If they have had a family member affected or seen people with the disease, they may also fear the crippling and deforming effects of the illness.

The reality though, is RA is an extremely serious condition that affects the entire body.

Of grave concern are the mortality statistics associated with the disease. Severe rheumatoid arthritis can shorten life expectancy by 10-15 years! A study conducted by the Center for Disease Control and Prevention in Atlanta looking at data accumulated from 1965 to 1990 demonstrated that patients with RA have a mortality ratio of 2.26 compared to the general population. That means they are more than twice as likely to die!

Rheumatoid arthritis is considered a systemic disease... one that affects many organ systems. For instance, inflammation of the cricoarytenoid joints- the vocal cords- is a common finding. And the lungs also may be affected early on. The initial manifestations may be subtle but as the disease progresses, the lungs can become so diseased that the respiratory complications also lead to death.

The heart is another target organ. When patients with RA undergo an ultrasound study of the heart, almost 50 per cent of patients who have no symptoms will have abnormalities of the pericardium, the sack that encloses the heart.

Another disturbing finding is that the risk of dying from coronary artery disease is five times greater in women with early-onset rheumatoid arthritis. The incidence of angina is also markedly increased compared with people without RA. Point of fact: cardiovascular causes are a primary cause of death with up to 42 per cent of rheumatoid arthritis deaths arising from this factor.

An additional sobering statistic is that RA patients have a 6-9 fold increase in risk of infection- related deaths. Predictors of risk for infections are increased age, male gender, chronic ling disease, low white blood cell count, diabetes, alcoholism, and organic brain syndromes, such as previous stroke or Alzheimer's disease. The risk for infections requiring hospitalization- serious infections- is also increased. These infections include, pneumonia, skin and soft tissue infections, sepsis (infection in the bloodstream, infected joints, abdominal infections, and osteomyelitis (bone infections).

Predictors of high risk for infection in patients with RA include: reduced functional capacity, an elevated erythrocyte sedimentation rate (ESR or "sed rate"), the presence of rheumatoid factor in the blood, the presence of rheumatoid nodules or other non-joint RA involvement.

Malignancies such as lymphoma are also increased in incidence in patients with severe RA. Low risk of lymphoma occurs with mild disease. However, as the severity of disease increases, the risk of acquiring lymphoma can increase to as high as 70 per cent in at least one study looking at this complication.

The eyes are not spared. Inflammatory disease of the eye such as scleritis and episcleritis can be a significant problem for RA patients. And Sjogren's disease, an autoimmune disease that affects the ability of the tear glands and saliva glands to produce secretions, is another potential pitfall that can arise.

Rheumatoid nodules, which are large collections of inflamed tissue can develop at the elbows, hands, and Achilles tendons. In patients with severe RA, vasculitis- inflammation of blood vessels- can cause skin ulcers to occur.

The blood is also affected. Many patients with rheumatoid arthritis develop the anemia of chronic disease. This is a form of anemia that is brought about by the chronic inflammation and is not responsive to iron therapy. Low white blood cell counts, high white blood cell counts, and increased platelet counts can also be seen.

The upshot is that when patients have rheumatoid arthritis, it's "not just a few aches and pains... nothing I can't live with..." It is a serious, potentially life-threatening condition.