Heart Disease In Rheumatoid Arthritis: Pathogenesis And Role Of Treatment
Patients with rheumatoid arthritis are at increased risk for ischemic and non-ischemic heart disease, secondary to subclinical pathological changes in heart muscle and in coronary vessels, according to a review published in Rheumatic & Musculoskeletal Diseases. Systemic inflammation is a risk factor for cardiovascular disease and treatment with conventional and biologic antirheumatic medications may have a significant impact on cardiovascular outcomes.1
Previous studies have established RA is an independent risk factor for premature atherosclerosis and reported that patients with RA are at an increased risk for CV events and cardiac mortality, compared with the general population.2-4 Chronic systemic inflammation secondary to rheumatic diseases is an important contributor for the increased CV risk among patients with RA and is associated with arterial stiffness, lipid-salvage mechanisms, and destabilization of plaques.4
In addition to inflammation, traditional CV risk factors, including hypertension, diabetes, dyslipidemia, obesity, smoking, family history and physical inactivity, may be more common among patients with RA, compared with the general population.7
Patients with RA were found to be at increased risk for myocardial infarction, major CV events and all-cause mortality, regardless of the presence of coronary artery disease . RA may precipitate CV events beyond CAD and in those with CAD may exacerbate the clinical risk of CV events.9
References
Haqqani: How Rheumatoid Arthritis Affects The Heart
Dr. Omar P. Haqqani
Earlier this year, the Mayo Clinic developed a method of predicting rheumatoid arthritis by analyzing biochemical metabolites in blood. The study was published in the journal Arthritis Research and Therapy and established the newly researched foundation of predicting RA through the use of blood samples. According to the Arthritis Foundation, people with RA are twice as likely to develop cardiovascular disease as those without it.
Rheumatoid arthritis
Rheumatoid arthritis occurs when the bodys immune system overreacts and attacks healthy cells when it should be fighting unhealthy ones. The joints are most vulnerable to RA and often, many joints may be affected at once by this autoimmune condition. The tissue within the joints becomes inflamed, leading to long-term tissue damage. This may cause deformity and chronic pain. In addition to joint and joint tissue damage, RA can also disrupt the function of the eyes, heart, lungs and other parts of the body.
Symptoms and risk factors of RA
Because RA affects joints so vociferously, joint pain is among the most notable symptoms, especially when aches and pains begin in more than one joint. Stiffness, swelling and tenderness appearing in multiple joints may also be symptoms. With RA, these symptoms can appear in the same parts on different sides of the body, such as both hands and the right and left knees. Weight loss, fever and general weakness or fatigue many also signal RA.
Ways to lower risk factors
Recognizing And Diagnosing Costochondritis
X-rays dont show soft tissue well and theres not a blood test for it, so costochondritis is typically diagnosed by a doctor through a physical exam. Older adults experiencing these symptoms may need to get an EKG to rule out the possibility of cardiac problems.
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According to Costochondritis, StatPearls medical education book published in January 2021, The most important part of the diagnosis of costochondritis is ensuring other, more deadly causes of chest pain have been ruled out. These can include acute coronary syndrome, pneumothorax, pneumonia, aortic dissection, pulmonary embolism, or an esophageal perforation.
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Rheumatoid Arthritis Linked To Irregular Heart Rhythm
People with rheumatoid arthritis are at a greater risk of irregular heart rhythm and stroke compared with the general population, finds a study published on bmj.com today.
Rheumatoid arthritis is already linked to an increased risk of heart attacks and heart failure, and is an important risk factor for stroke. But no study has yet examined whether it increases the risk of atrial fibrillation a condition associated with an increased long term risk of stroke, heart failure, and death.
So a team of researchers set out to examine the risk of atrial fibrillation and stroke associated with rheumatoid arthritis in the Danish population.
The study involved more than four million people, of which 18,247 had a diagnosis of rheumatoid arthritis. Participants were followed up for an average of five years, during which time cases of atrial fibrillation and stroke were recorded.
The results show that patients with rheumatoid arthritis had a 40% increased risk of atrial fibrillation compared with the general population with women at slightly higher risk than men. This corresponds to one new case of atrial fibrillation per 12 rheumatoid arthritis patients followed for 10 years after diagnosis.
Patients with rheumatoid arthritis also had a 30% increased risk of stroke compared with the general population .
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Atrial Fibrillation Link Also Seen
A population-based study in Denmark also found that patients with RA had about a 40 percent increased risk of atrial fibrillation over people who didnt have the disease. In this first study that focuses on AF risk, researchers extend the possible risk factors the inflammatory arthritic disease causes.
Dr. Husni says more studies and increased awareness in the medical community are essential to improve outcomes for patients with inflammatory arthritis.
Traditional risk score calculations can underestimate CV risk in our patients, she says. These patients have not been traditionally included in the large prospective clinical trials for primary cardiac prevention, making it difficult to extrapolate cardiac risk management in the general population to patients with RA, lupus and psoriatic arthritis.
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Peripheral Vascular Disease And Peripheral Artery Disease
The arteries and veins that carry blood throughout your body are collectively your vascular system. Any disease of the vascular system outside of the heart is known as peripheral vascular disease .12
Peripheral artery disease is a type of PVD. Veins carry oxygen-rich blood from the rest of the body to the heart, while your arteries bring this blood from the heart to the rest of the body. PAD occurs only in the arteries, slowing blood flow return. This causes the arms and legs to suffer from the decreased blood supply. PAD is caused by a build-up of plaque in the arteries.12
Along with the traditional risk factors for PAD, those with RA who take steroids are at an increased risk for this type of heart disease.11
Can Rheumatoid Arthritis Affect Your Heart
Heart Disease, Inflammation, Rheumatoid Arthritis
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In 2013, the Centers for Disease Control and Prevention announced data estimating that 52.5 million U.S. adults suffer from arthritis equating to about 23% of the population. The most common types of arthritis are osteoarthritis and rheumatoid arthritis. About 1.5 million people in the United States have rheumatoid arthritis and nearly three times as many w2omen have the disease as opposed to men.
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How Does Rheumatoid Arthritis Affect The Heart And Lungs
When your RA flares up, the membrane surrounding your heart can also become inflamed. And the worse your RA is, the worse your flares will be, and this means a higher chance your heart is inflamed.
The inflammation around your heart is called pericarditis. With time, all that inflammation causes the heart membrane to get thick and tight, making it harder for your heart to do its job.
Rheumatoid nodules on your heart are also a real possibility. These firm lumps are a complication of RA and affect the way the heart works.
Irregular Heartbeat
People with RA have an increased risk of atrial fibrillation , a condition that causes irregular heartbeats. And AFib is also linked to strokes.
According to one Danish study, adults with RA are 40 percent more likely to have AFib, and they are also 30 percent more likely to have a stroke.
Congestive Heart Failure
A study reported in 2005 from researchers at the Mayo Clinic found RA patients had twice the risk for congestive heart failure. The risk was higher for RA patients who were RF-positive, and in all RA patients, the increased risk was there even in the absence of other cardiovascular risk factors.
A second Mayo Clinic study, this one reported in 2008, found when heart failure presented itself in RA patients, patients had no evidence of signs or symptoms, this compared to people without RA. Death with the first year following heart failure with RA is also higher.
Rheumatoid Arthritis and Cholesterol Levels
Breathing Problems
Rheumatoid Arthritis Medications Can Affect Heart Disease Risk
Rheumatoid arthritis is typically treated with different medications to control pain and inflammation. Some of these drugs can also affect heart disease risk, so its important for you to be aware of these connections and discuss them with your rheumatologist.
Corticosteroids
Corticosteroids like prednisone are the biggest offenders, so consider their impact on heart health just one more reason to avoid them or use as low a dose as necessary to keep your RA in check.
Steroids can raise levels of lipids like LDL cholesterol and triglycerides, says rheumatologist Christie Bartels, MD, Associate Professor at the University of Wisconsin in Madison. They can also make your blood pressure higher, make your blood sugar higher, and cause changes in systemic inflammatory responses.
Non-steroidal anti-inflammatory drugs
NSAIDs, which include medications like ibuprofen and naproxen and prescription versions, are another class of medication that you ought to be cautious about.
Although NSAIDs are, by definition, anti-inflammatory, most of them inhibit certain enzymes that may, in turn, raise the risk of cardiovascular events. That said, a meta-analysis that specifically looked at NSAID use in RA patients found that these drugs do not increase the risk of heart disease.
If you must use NSAIDs regularly, naproxen is probably your best bet, says Dr. Bartels. It has a slightly different mechanism of action so its less likely than other NSAIDs to lead to cardiovascular problems.
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Unusual Symptoms Of Ra
While rheumatoid arthritis most commonly causes joint pain, inflammation, and swelling, systemic symptoms such as fatigue can affect the whole body. Inflammation from rheumatoid arthritis can also target other systems of the body, resulting in a variety of different symptoms. These are known as extra-articiular manifestations.
Rheumatoid Nodules Or Granuloma
Rheumatoid nodules may occur in all organs and also in the epicardial fat, epicardium, myocardium, interventricular septum, chordae tendinae, aorta and valves. These nodules may cause functional impairment such as arrhythmias and valve disease. There is no evidence that immunosuppressive treatment may resolve these cardiac nodules, and if functional cardiac impairment occurs, symptom-reducing drugs or surgical treatment should be considered.
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Rheumatoid Arthritis And Heart Disease
Learn why RA puts you at a greater risk for heart disease and what you can do to protect yourself.
Swollen and painful joints arent the only things you need to worry about when you have rheumatoid arthritis . People with RA are almost twice as likely to develop heart disease as those without the condition. Having RA makes you more likely to experience a serious cardiovascular event like a heart attack or stroke.
But just because your joints are inflamed, that doesn’t mean youre destined to have heart troubles. With the right screening and preventive measures, you can keep your heart and blood vessels healthy.
RA and Heart Disease: Whats Behind the Connection?
Two factors come together to increase your risk: chronic inflammation and shared risk factors.Inflammatory substances called cytokines fuel joint destruction in RA and blood vessel damage in cardivascular disease . Inflammation causes plaque build-up in the arteries, which slowly narrows blood vessels and blocks blood flow, and is the main cause of heart attack and stroke.
The other reason people with rheumatoid arthritis are more likely to develop heart disease is shared risk factors like these:
High blood pressure A number of factors increase blood pressure in people with RA, including a lack of exercise and drugs used to treat the disease . People with RA also have less-elastic arteries that can narrow, which lets less blood through and increases blood pressure.
Reduce Your Risks
Monitor Your Heart Health
Track Your Heart Health
If you have rheumatology arthritis, it is important to constantly monitor your heart health, especially if any of your family members have some heart disease.
Find out if you have increased blood pressure, diabetes, or high cholesterol. Keep up with your general check-ups to monitor your heart health and find out if you have an increased risk of heart diseases.
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Arthritis & Heart Disease
Why People With Arthritis Are at Greater Risk for Heart Disease
Youre probably all too aware of how arthritis affects your joints. But the unfair news is that having arthritis osteoarthritis , but especially inflammatory conditions like rheumatoid arthritis , gout, lupus and psoriatic arthritis puts you at increased risk of developing heart disease. That includes heart attack, stroke, atrial fibrillation , high blood pressure, heart failure and atherosclerosis .
People with RA tend to be at highest risk. More than 50 percent of premature deaths in people with rheumatoid arthritis result from cardiovascular disease, according to a 2011 review of 24 mortality studies published in Nature Reviews Rheumatology.
People with gout also have a higher risk of heart attack and death from cardiovascular and coronary heart disease. High uric acid levels a cause gout have been linked to a 44% increased risk of high blood pressure, according to a 2011 review published in Arthritis Care & Research.
As for people with OA, a study of 8,000 people in Finland, published in the Annals of Rheumatic Diseases, found that men with OA in even a single finger joint were 42% more likely to die of cardiovascular disease than those who didnt have OA. Women were at a 26% higher risk than those without the disease. The link may be excess weight.
So, why the double whammy of increased heart disease risk when you have arthritis?
Chronic Inflammation
Psoriasis And Arthritis Can Increase Heart Attack And Stroke Risk
Africa-Press Mauritius. Arthritis is the leading cause of pain and disability. The disorder typically causes pain and inflammation in the joints, and can affect people of all ages.
It is an extremely debilitating condition that can force people to give up work or favourite hobbies. There are several kinds of arthritis, including the commonly known osteoarthritis.
This type is related to wear and tear of the joints due to older age, or damage from sports and other activities. But other kinds of arthritis known as inflammatory arthritis can affect the organs and skin, too.
In our newly published research, we wanted to find out the associated cardiovascular risks that come with types of inflammatory arthritis particularly rheumatoid arthritis and psoriatic arthritis.
Researchers have found that people with rheumatoid arthritis have higher rates of cardiovascular disease. And those with rheumatoid and psoriatic arthritis also have an increased risk of developing other conditions, such as skin and heart disorders.
However, it is not entirely clear whether those with psoriatic arthritis a joint condition that affects around 30% of people with the skin condition psoriasis are subject to a higher risk of cardiovascular disease, too.
We cannot simply say arthritis causes heart problems, as there are numerous factors at play. There are several things that can affect everyones heart health whether they have inflammatory arthritis or not.
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How To Reduce The Risk
Even though RA increases the risk of heart disease, you can work with your doctor to lower your risk.
One of the easiest ways to protect yourself from heart disease related to RA is taking the medications your doctor prescribes to control the inflammation from RA. Disease-modifying antirheumatic drugs reduce the inflammation associated with RA and may reduce the risk of heart disease.
Though people living with RA have an increased risk of heart disease, medical guidelines in the United States dont have specific recommendations to reduce heart disease if you have RA. However, the current European League Against Rheumatism recommends you should be screened every 5 years for risk factors of heart disease.
You can also make some lifestyle changes to help lower your risk of heart disease. The suggests the following tips to reduce the risk of heart disease:
- eating a balanced diet of vegetables, fruits, and whole grains
- getting at least 150 minutes of aerobic exercise per week
- maintaining a moderate weight
Understanding The Lipid Paradox
Strangely enough, doctors have noticed a lipid paradox: People with inflammatory arthritis tend to show misleadingly good results on standard tests like the American Heart Associations risk calculator. Factors like low bad LDL cholesterol levels might make the person look healthy from the outside, even though the person is at high risk of heart disease.
Scientists arent sure whats driving the paradox, but some early evidence suggests that the LDL cholesterol particles are smaller and denser than normal in people with inflammatory arthritis, so they might cause problems that standard tests wont catch, says Dr. Gulati.
Many people will appear to be low risk, says Dr. Gulati. That isnt somebody you would necessarily look at their lipid panel and know theyre at risk for heart disease.
But those tests dont paint the whole picture. Arthritic inflammation is a risk factor in and of itself, even though its not reflected on typical tests.
Thats why its important to pay attention to your heart with these tips specifically relevant to people with inflammatory arthritis:
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