RA and UTIs: What women with RA should know

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Rheumatoid arthritis (RA) is a chronic inflammatory disorder that is well known for affecting the joints, but it also affects the skin, heart, lungs, and other body systems. There are problems associated with RA that you may have never heard of, from itchy skin to severe infections. If you are an older woman living with RA, many factors can add up to create the perfect conditions for a urinary tract infection (UTI). Learn about the association between RA and UTIs and the measures you can take to prevent and treat UTIs if you find yourself at risk.

For people living with rheumatoid arthritis, both their disease and treatment can put them at higher risk of infections.

By nature of RA being an inflammatory disease, people with RA have an overactive immune system. The body attacks its own cells, leading to swelling and pain. The dysfunctional immune response in people with RA also makes them susceptible to infections of all kinds, especially for people with moderate to severe active disease.

Not only does RA itself increase the risk of infection, but treatment for RA with disease modifying anti-rheumatic drugs (DMARDs), steroids, and immunosuppressants can also weaken the immune system. These medications are intended to reduce the strength at which your body attacks itself, but they also bring down the body’s defense against bacteria that may enter the system.

Regardless of whether or not they have rheumatoid arthritis, older women are already at an elevated risk of urinary tract infections. Postmenopausal women are actually at the highest risk for repeat cases. While the exact reasons why are not quite clear, older women have a few characteristics that may increase their susceptibility to UTIs, such as changes in pelvic anatomy and lower estrogen levels. Adding on to this, many older women may regularly experience different symptoms and miss the fact that they could be attributed to a UTI. Waiting to treat an UTI increases the risk of developing a more serious infection that travels up to the kidneys and increases the likelihood of getting UTIs again in the future.

For older women with rheumatoid arthritis, a combination of three factors — the general infection risk from RA, a weakened immune system from RA treatment, and the physiological risk for UTIs as a postmenopausal woman — can lead to a major risk for repeat, serious UTIs. One study found that the risk of UTIs in women with RA was about two times higher than for those in the general population.

The relationship between RA and UTIs is thought to be bidirectional. A recent paper published in Nature hypothesized that the antibiotics that treat bacterial infections such as UTIs may cause flare-ups of RA. In past literature, antibiotic treatment has even been considered a direct cause for an initial RA diagnosis. However, the mechanism for this relationship is still unclear.

The more you know about your risks for UTIs, the earlier you can identify any risk factors and symptoms. Urinary tract infections are caused by a buildup of bacteria in the urinary tract that can spread up to the bladder and kidneys. This risk may be increased by unprotected sex, sitting still for a long period of time, and wearing constricting fabrics. Once you have had one UTI, you are at elevated risk for getting more infections in the future (recurrent infections). However, you can take steps to lower your risk as much as possible.

For postmenopausal women, signs of a UTI may look a bit different than for others experiencing UTIs. Look out for symptoms such as:

• Fever
• Achiness
• Nausea
• Fatigue
• General malaise
• Forgetfulness

If you feel unwell, it is important to see your doctor as soon as possible, making your risk factors clear. Your medical provider should test to see if there is bacteria in your urine. If there is, and you are experiencing symptoms, you will likely be diagnosed with a UTI.

Typical treatment for a symptomatic urinary tract infection is antibiotics, which should be taken exactly as directed by a doctor, even if symptoms disappear part way through treatment. Taking the full course of antibiotics helps ensure that you do not leave some of the bad bacteria in your system, as that bacteria can become resistant to that antibiotic in the future. Postmenopausal women may also be treated with vaginal estrogen therapy, as estrogen has protective effects against infection.

Older women with RA should understand their increased risk for UTIs, and know what to do if they are aware of any signs or symptoms of disease. UTIs are more easily identified and managed if you know what to look out for and how to protect yourself. No matter your risk of infection, it is essential to take control of your urinary tract health.

Note: this is not intended to replace medical advice. Please follow instructions from your doctor.

1. Rheumatoid Arthritis and Itching — myRAteam
2. Rheumatoid Arthritis — Mayo Clinic
3. Infections in rheumatoid arthritis — Current Opinion in Rheumatology
4. Understanding Urinary Tract Infections — AARP
5. Serious infection risk in rheumatoid arthritis — Rheumatic & Musculoskeletal Diseases
6. Urinary tract infections in patients with rheumatoid arthritis — Clinical Rheumatology
7. Antibiotic treatment and flares of rheumatoid arthritis — Nature
8. Urinary Tract Infection (UTI) — Mayo Clinic