Rheumatoid arthritis (RA) is a disease that affects around 1% of the general population. If you’re one of the 1.5 million Americans living with RA, you may be familiar with the symptoms – achy, stiff, swollen joints starting in the hands and feet but then progressing to larger joints, such as the shoulders and knees, fatigue, weight loss, anemia (low iron), and joint deformities. But did you know that your joints aren’t the only things that need attention if you’re living with RA? Having rheumatoid arthritis can put your hearing at risk, too.
The Low-Down on Rheumatoid Arthritis (RA)
RA is a chronic (that is, long-term), systemic (affecting the entire body), autoimmune (the body’s immune system attacks and damages its own tissues) disease. The main target of this misguided immune system is the synovial tissues within your joints, which is why RA is often characterized by painful, swollen, deformed knuckles. However, being a systemic condition, RA may also affect other tissues such as your heart and lungs, or muscles and ligaments.
It doesn’t take much imagination to figure that RA can have a significant impact on one’s lifestyle and overall wellbeing. Arthritis is considered a leading cause of work disability among adults in the US (including all types of arthritis, not just RA). It also more than doubles the risk of suffering a fall and subsequent injury compared to adults without arthritis.
The cause of RA isn’t well understood, though several risk factors have been identified. Women are 2-3 times more likely to experience RA compared to men, and it’s most commonly diagnosed in adults over the age of 60. Certain lifestyle factors, such as tobacco smoking, can also increase the risk of triggering RA.
Fortunately, there are various treatments to manage RA and its debilitating symptoms. Under the care of a medical specialist called a rheumatologist, treatments for RA can include medications, physical therapy, and surgery. Lifestyle changes you can make to help your symptoms include quitting smoking, managing your weight to reduce the strain on your joints, and maintaining a well-balanced diet to help combat inflammation.
Your Ears and RA
Research suggests that people with RA may want to add an audiologist to their healthcare team, in addition to a rheumatologist. Various studies have found that sensorineural hearing loss is present in people with RA at a rate as high as 80%. Sensorineural hearing loss is a type of hearing impairment arising from damage to the inner ear and its neural pathways. Conductive hearing loss is the second most common type of hearing impairment found in people with RA, involving damage to the outer and middle ear. Mixed hearing loss (a combination of sensorineural and conductive causes) has also been reported in people with RA.
It’s not fully understood how RA relates to hearing impairment; however, there are several theories:
- The disease causes arthritic damage of the joints between the bones of the middle ear (the malleus, incus, and stapes), which leads to conductive hearing loss
- Inflammation of the tissues and structures within the ear, such as the auditory nerve or the cochlea, which leads to sensorineural hearing loss
- Medications commonly used in RA can be damaging to the auditory system (ototoxic), including salicylates, non-steroidal anti-inflammatories (NSAIDs), and disease-modifying antirheumatic drugs (DMARDs), possibly through impairing blood flow to the delicate structures of the ear
- Rheumatoid nodules, hard bumps under the skin, may form in the ear and impede the conduction of sound signals
Smoking and Alcohol Consumption Are Risk Factors for Rheumatoid Arthritis
Studies have also noted that certain environmental or lifestyle factors can exacerbate or increase the risk of hearing loss in those with RA.
Smoking, whether active or passive (breathing in someone else’s cigarette smoke) are at a higher risk of experiencing hearing loss. Even without RA, smoking is known to be detrimental to your ear’s tiny (and very fragile) hair cells, leading to sensorineural hearing loss. In the case of RA, smoking also increases the likelihood of developing rheumatoid nodules, which, as we know, can lead to conductive hearing loss. Alcohol consumption and exposure to loud noises are also known risk factors for hearing loss, in people both with and without RA.
Interestingly, attaining a higher level of education may be protective against hearing loss in RA. The authors of this particular study hypothesized that this was because those with higher levels of education were more likely to work in occupations that didn’t involve excessive noise.
Help, I Have RA and I Don’t Think I Can Hear My Joints Creaking Anymore
Do you think you might have hearing loss? The first thing to do would be to contact your local hearing center for a hearing test. Your hearing specialist or audiologist will perform a series of tests, most likely including one called pure tone audiometry. This will involve a series of beeps or tones at varying frequencies. As you respond to each tone that you’re able to hear, this will help to map out your hearing ability. In RA, high frequencies are the most commonly impaired in cases of sensorineural hearing loss. However, middle and low frequencies may be affected, as well.
If you think your arthritis is causing you to experience hearing loss, your rheumatologist needs to be aware too, since it may affect the management of your RA. If any of your RA medications are thought to be ototoxic, you may need to be changed to an alternative drug if one is available. Your hearing difficulties can also potentially be reversed with other treatments, including:
- Corticosteroid medications
- Medications to increase blood circulation to the ears (vasodilators)
- Anti-inflammatory medications
- Reducing or eliminating contributing lifestyle factors, such as smoking, alcohol consumption, and excessive noise exposure
After trying other therapies, if there is any residual, permanent hearing loss, your hearing specialist may offer to fit you with a hearing aid. Since hearing loss has the potential to negatively impact your quality of life, it may be worth investigating this option if you find yourself withdrawing from social situations, avoiding conversation, or feeling depressed.
Your hearing is probably the last thing you want to worry about when you’re already dealing with a bad hip and painful, knobbly knuckles. However, your hearing is too important to lose. If you think your hearing might have been affected by rheumatoid arthritis, visit your local hearing center.