Massage Therapy Journal Summer 2026

38 • Massage Therapy Journal

AMTA Continuing Education

asymptomatic in early stages but later cause eye pain, “haloing” and vision loss. 19 • Hearing loss . RA may increase the risk of both conductive and sensorineural hearing loss. (In conductive hearing loss, damage to the outer and middle portions of the ear affect the ability of the ear to conduct sound; in sensorineural hearing loss, damage is deeper in the ear, affecting the inner ear and nerves, disrupting the brain’s ability to interpret sound). 20 A 2016 review found that studies reported rates of sensorineural hearing loss in people with RA ranged from 25–72 percent. 20 In addition, various studies have linked hearing loss to use of over-the-counter analgesic drugs such as ibuprofen. Lastly, the formation of rheumatic nodules in the ear may damage the middle and outer portions of the ear, causing conductive hearing loss that makes it difficult for the ear to conduct sound, and chronic inflammation may also damage nerve cells in the inner ear, making it hard for the ear to send signals to the brain or for the brain to interpret these signals. 16 • Fibromyalgia . Although much about fibromyalgia (FMS) still is not understood completely, two things are clear: it affects a disproportionate number of people with RA 16 and fibromyalgia is a syndrome marked by widespread pain, fatigue, poor sleep and memory problems, plus headache, irritable bowel syndrome and increased sensitivity to temperature changes, light and sound. A hallmark is hypersensitivity to pain, known as central sensitization. 16 In some respects, FMS can resemble RA, which is why patients with both conditions sometimes go years without It’s not clear how many people with RA have fibromyalgia. Researchers used to think it was around 20–30 percent, but that number may be too low. “Once patients are diagnosed with RA or lupus, rheumatologists tend to attribute all pain and fatigue to the autoimmune disease. What can end up happening is that the RA is the fibromyalgia being diagnosed. Unlike arthritis, however, FMS does not affect or damage joints or other tissues.

over treated with disease-modifying drugs or biologics because symptoms such as fatigue and memory problems persist even after joint swelling and inflammation are reduced. Persistence of symptoms should be a blinking neon light to look for central sensitization,” according to Dr. Daniel Clauw, MD, a professor at the University of Michigan and noted fibromyalgia researcher. 21 COVID-19 and RA: What We Know People with RA are at a higher risk for infections, including COVID-19, a highly infectious virus that spreads through airborne respiratory droplets. People with RA may also be at higher risk for severe symptoms and complications, especially when their RA is more active and during exacerbations, and are more likely to end up in the hospital. This risk is related to immune system suppression and to the use of RA therapies that further contribute to that suppression. People with RA comorbidities who are older adults or whose RA is severe and unmanaged, or who have been recently hospitalized for respiratory illness, are especially at risk for more serious complications of COVID-19 or death. RA that affects organs or systems other than the joints, particularly the lungs, could also predict worse outcomes with COVID-19. 22 Certain medications prescribed to treat RA may negatively affect a person’s ability to fight COVID-19: • Global Rheumatology Alliance researchers found that people with RA who were taking rituximab or JAK inhibitors (such as tofacitinib or upadacitinib) when they were infected with COVID-19 were more likely to have severe illness requiring hospitalization than patients taking TNF inhibitors (such as infliximab, etanercept, adalimumab, or golimumab), abatacept, or interleukin-6 inhibitors like tocilizumab. 22 • In addition, contracting COVID-19 while using a corticosteroid (often prescribed for treatment of autoimmune diseases such as

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