Mechanisms Of Ra Pertinent To Cardiovascular Disease
Emerging evidence suggests that T lymphocytes play a crucial pathogenic role in both RA and heart disease . The major risk gene for RA, HLA-DRB1, predisposes to disease by promoting the selection and survival of autoreactive CD4+ T cells. HLA-DRB1 alleles are also associated with increased risk of MI and various forms of non-RA-associated heart disease. As in heart disease, T cells isolated from the joints of patients with RA have enhanced production of interferon- and interleukin-17, which presumably mediate chronic inflammation . The proven efficacy of antagonizing T-cell co-stimulation is perhaps the most compelling evidence that T cells are pathogenic in RA . Similarly, percutaneous stents that elute T-cell inhibiting drugs prevent in-stent restenosis and repeat re-vascularization in CAD.
Heart And Blood Vessel Disease
Pericarditis, or inflammation of the membrane that surrounds your heart, usually develops during flares. Flares are times when your RA is worse.
If it happens a lot, pericarditis can make the membrane thicker and tighter. That can interfere with your hearts ability to work the way it should.
Rheumatoid nodules can also form on the heart and affect the way it works.
Inflammation of the heart muscle itself, called myocarditis, is a rare complication.
Heart disease doesnt always have symptoms before a crisis. Your doctor can spot some problems during a checkup and may recommend lifestyle changes or medication.
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Rheumatoid Arthritis And Your Kidneys
Learn about the link between rheumatoid arthritis and the increased risk of serious kidney disease, and what to do to protect yourself.
Evidence suggests an elevated risk of kidney disease is a serious health consequence of rheumatoid arthritis . Kidney disease also raises your odds of developing heart disease. Since people with RA already have double the average risk for cardiovascular disease, that can spell serious trouble.
Kidneys Diseases and RA
Some people with RA have a one in four chance of developing kidney disease compared with a one in five chance for people who dont have it. However, the type of kidney disease is not always clear because most patients with RA and chronic kidney disease do not get a kidney biopsy. Among patients who did get biopsies, a variety of renal diseases have been found, including a protein deposit that causes kidney failure, a buildup of immune substances within the kidney and other diseases that affect the tiny filters in the kidneys.
Science Behind the RA-Kidney Link
Symptoms of Kidney Disease
Often, people dont have symptoms of kidney disease until the disease is advanced. Some symptoms, such as fatigue and appetite loss, mimic those of RA. Always tell your doctor about any new or worsening symptoms. Symptoms of advanced kidney disease include:
- Puffiness around the eyes
- Family history of kidney disease
Safeguard Your Kidneys
You can protect your kidneys in several ways:
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Key Points About Reactive Arthritis
- Reactive arthritis is a type of arthritis caused by an infection. It may be caused by Chlamydia trachomatis, salmonella, or another infection.
- The condition may cause arthritis symptoms, such as joint pain and inflammation. It may also cause symptoms in the urinary tract and eyes.
- Treatment includes antibiotics for the infection, plus medicines to reduce the joint pain and inflammation.
- Most people recover fully from reactive arthritis.
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Regulator Of The Costimulatory Signal Of T Cell Activation
Abatacept has a short-term effect on endothelial function. The short-term improvement of microvascular endothelial function on abatacept administration coincides with the gradual deterioration of vascular endothelial function , a phenomenon that can induce a shift in the polarization of adipose tissue macrophages from the pro-inflammatory M1 phenotype to the anti-inflammatory M2 phenotype , increase the proliferation and inhibitory activity of Treg cells , improve insulin resistance, increase insulin sensitivity index, and reduce the risk of CVD . Compared with TNF inhibitors, the risk of using abatacept combined with CVD in patients with basic diseases is reduced by 20%, which indicates that abatacept has higher CVD safety than TNF inhibitors, especially for patients with RA who are older and have CVD .
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You Can Manage Pain With Exercise
Even though exercising is the last thing on your mind whenexperiencing RA pain, its a critical tool for pain management. This is animportant rheumatoid arthritis fact that many people overlook. If youre notaccustomed to routineexercise, start slowly and ease into a low-impact program thats joint-friendly.Gradually increase your exercise time and intensity as is tolerable for you.
Yoga and tai chi can help increase mobility and evenalleviate RA pain.
Ra Flares Can Have Triggers
It is possible for a specific activity or event to initiate a flare-up. The activity or event sets off inflammation in the body that is difficult to stop. A flare may be triggered by:
- An illness, such as the flu
- An injury or surgery
Triggers vary from person to person. In addition, not all RA flares have clear triggers.
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What Is The Outlook For People With Rheumatoid Arthritis Rashes
There are no permanent solutions that can completely prevent RA rashes from occurring. Doctors may try a combination of medications to help you manage your condition. These treatments may reduce inflammation and minimize joint damage.
Its important that people with RA take measures to live as healthy a lifestyle as possible. Examples of lifestyle practices that may benefit a person with RA include:
- Getting plenty of rest, which can help to reduce fatigue symptoms and minimize joint inflammation.
- Exercising whenever possible, which can help to enhance joint mobility and build strong, flexible muscles.
- Taking measures to cope with stress, such as meditation, reading, taking a walk, or doing other activities to promote relaxation.
- Eating a balanced diet full of fruits, vegetables, whole grains, and lean proteins. This can help you maintain a moderate weight, which is important in supporting joint health.
Inflammation Can Trigger Atherosclerosis
Inflammation actually helps in small doses. But if it becomes ongoing, or chronic, thats harmful. And this is exactly what occurs in RA and heart disease.
The same immune cells that are overly active in rheumatoid arthritis are also important for the development of plaque inside the blood vessels and contribute to heart disease, explains Dr. Sallam.
That plaque is made of cholesterol, fat, and other substances, and it can build up on the walls of your arteries, which narrows and stiffens them, impeding blood flow. This disease process is called atherosclerosis. It can affect arteries anywhere in your body. If it develops in those that supply blood to your ticker, it can cause , the most common type of heart disease.
The cause of atherosclerosis remains unknown, but it appears to begin when damage to the arteries occurs. Many things can damage the arteries, including smoking, high cholesterol, and .
Another common source of damage: inflammation triggered by your immune system. That may explain the link between RA and heart disease.
Rheumatoid arthritis is a condition where, if uncontrolled, there are high levels of systemic inflammation, which in turn leads to increased atherosclerosis, coronary disease, and risk for heart attack, says Jim Liu, M.D., a cardiologist at the Ohio State University Wexner Medical Center in Columbus, OH.
Coronary artery disease and are the most common types of heart disease linked to RA, says Dr. Liu.
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What Are The Factors That Increase The Risk Of Heart Failure With Rheumatoid Arthritis
Causes responsible for an increased risk of heart failure in rheumatoid arthritis include the following:
Inflammatory mediators may have a role in the onset of heart failure in RA. A study on people with RA who developed heart failure reported a high erythrocyte sedimentation rate > 39 mm/hour 6 months after the new onset of heart failure. Most individuals developed anemia 6 months after developing heart failure, which indicates the presence of systemic inflammation.
A cross-sectional study reported that an ESR of > 16 mm/hour and a C-reactive protein of > 10 mg/L were both related to an elevated risk of heart failure, suggesting that there is a significant relationship between active inflammation and heart failure in individuals with RA.
Antirheumatic drug therapy
Disease-modifying antirheumatic drugs can affect the immune status adversely and increase the predisposition to systemic infections and heart muscle inflammation.
Ischemic heart disease
In the general population, the most common cause of heart failure owing to systolic dysfunction is ischemic cardiomyopathy. Because the risk of coronary disease in people with RA is higher than that in the general population, heart failure occurs from ischemic cardiomyopathy in people with RA.
The Ticket To A Healthier Ticker
In general, the more severe your RA, the greater your chance of developing heart problems. To protect your heart, its important to get inflammation under control. And the sooner you can do this the better, because the risk of having a heart attack goes up within the first year after being diagnosed with RA. Work with your doctor to find the arthritis treatment thats most effective for you.
To further reduce your risk of heart problems, stay physically active, eat a balanced diet, maintain a healthy weight, and dont smoke. Ask your doctor or a dietitian for suggestions on making lifestyle changes successfully.
High blood pressure, unhealthy cholesterol levels, and diabetes only add to your risk of developing heart disease. If you need medication to treat any of these conditions, be sure to take it as directed.
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Heart Disease Often Missed In Rheumatoid Arthritis
People with rheumatoid arthritis are at high risk of heart attack, atrial fibrillation, heart failure, and stroke. Heres what you need to know.
People who have rheumatoid arthritis are roughly twice as likely as the general population to experience heart failureand 50 percent more likely to have a heart attack, according to the Cleveland Clinic in Ohio. But despite this increased risk, people living with RA are screened for heart disease far less than other high-risk patients.
In a recent review, Nature Reviews Rheumatology, the authors call for improvements in CVD preventive care in patients with RA. According to the lead author, Anne Grete Semb, MD, PhD, a senior researcher at the Leader Preventive Cardio-Rheumatology Clinic at Diakonhjemmet Hospitaal in Oslo, catching risk factors early is particularly important in people with RA to prevent a fatal cardiac event.
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
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The Lungs And Heart May Be Affected
Research published in Rheumatology International has found that JIA can interfere with how well the heart pumps blood, particularly through the left ventricle. This can lead to high blood pressure and breathing problems. Along with inflammation of the pericardium patients may also have long-term changes of inflammation and irritation in the lungs and pleura , says Dr. Oller. This over time can lead to lung disease.
Scarring Within The Lungs
In medical speak, its called interstitial lung disease a broad category of lung disorders, most of which lead to scarring in the tissue between the air sacs of the lungs . Chronic inflammation from rheumatoid arthritis can lead to this scarring over time, the buildup of scar tissue makes the lung tissue stiff, which interferes with breathing and can be difficult to treat.
ILD is the most common and most serious lung complication for people with RA: Research shows lung disease alone accounts for up to 20 percent of deaths in rheumatoid arthritis patients, and most are attributed to ILD. Though its rare, this scarring may also occur in a small number of people with ankylosing spondylitis.
Symptoms include shortness of breath and dry cough, as well as fatigue and weight loss. But by the time these signs appear, irreversible lung damage has often already occurred. Some estimates suggest about 30 percent of patients with rheumatoid arthritis have ILD, without obvious symptoms.
What Is A Rheumatoid Arthritis Rash
Rheumatoid arthritis is an autoimmune disease in which the bodys immune system attacks itself and inflames the protective membrane inside the joints. This can result in symptoms that range from mild to severe.
Symptoms are mostly related to joint problems. But you may also experience flare-ups in which your symptoms are worse. This may include rashes on the body due to inflammation.
Other skin conditions associated with RA can include:
- Neutrophilic dermatoses:These can include Sweets syndrome, pyoderma gangrenosum, and rheumatoid neutrophilic dermatitis.
- Urticaria:Urticaria, or hives, may occur.
- Rare skin conditions: Sometimes rare skin reactions such as erythema diutinum can occur in people with RA.
- Reactions to medications: Medications such as methotrexate can trigger rheumatoid vasculitis and periungual infarcts, or tissue death in the nails due to lack of blood supply.
In most cases, there are treatments available for RA-related rashes.
People with RA can also experience RV. RV is a rare complication experienced in only
Rheumatoid Arthritis And Heart Disease: Understanding The Connection
Physicians have long known that people with rheumatoid arthritis and other rheumatic conditions such as lupus are more likely to die at younger ages than are those without these conditions. Even with advances in treatment, the gap in life expectancy remains.
No one knew why until 15 years ago. That’s when researchers at Mayo Clinic helped establish that people with rheumatoid arthritis have a greater chance of developing various types of cardiovascular disease.
“We now know that rheumatoid arthritis is associated with an increased risk of heart and vascular disease,” says senior researcher Sherine E. Gabriel, M.D., a rheumatologist and epidemiologist in the Department of Health Sciences Research at Mayo Clinic’s campus in Rochester, Minnesota. “What is less understood is why people with rheumatoid arthritis develop that increased risk.”
The evidence increasingly points to inflammation as a major contributor to that increased risk of cardiovascular disease.
In rheumatoid arthritis, the immune system attacks the synovium the lining of the membranes around the joints. The resulting inflammation thickens the synovium, which can, in turn, eventually destroy cartilage and bone in the joint.
Inflammation can also cause the inner linings of arteries to swell. This narrows the arteries, raises blood pressure, and reduces blood flow to the heart and other organs.
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Epidemiology Of Heart Disease In Ra
Patients with RA have a 1.52.0 fold increased risk of developing coronary artery disease compared with the general population , similar in magnitude to the risk imparted by diabetes mellitus . This increased CAD risk is evident even before the clinical recognition of RA: at diagnosis, individuals with RA were over three times as likely to have had a prior myocardial infarction than subjects without RA . An expert committee of the European League Against Rheumatism has recommended that CV risk scores be multiplied by 1.5 in some patients with RA to reflect their increased risk of heart disease .
Patients with RA also have twice the risk of developing heart failure . This risk is more pronounced in the RA patients who are rheumatoid factor positive than among seronegative patients. Patients with RA are less likely to have typical signs and symptoms of heart failure, tend to be managed less aggressively and have poorer outcomes . Importantly, patients with RA and heart failure are more likely to have a preserved ejection fraction , and less likely to have clinical evidence of CAD. Patients with RA may have a reduced likelihood of developing heart failure after MI . Collectively, these findings suggest patients with RA are more likely to have heart failure due to diastolic dysfunction, which may be related to systemic inflammation.
Mortality/morbidity From Cardiovascular Disease In Ra
Rheumatoid arthritis patients suffer from excess mortality from cardiovascular disease . CVD is the leading cause of death even in the general population however, RA is associated with an increased risk of developing CVD by almost two fold, a risk magnitude comparable to that of diabetes mellitus . RA patients are twice as likely to experience a silent myocardial infarction compared to non-RA subjects and carry a higher burden of coronary plaques even in the absence of clinical history of coronary artery disease . Following a new CVD event, patients with RA have a 17.6% 30-day CVD mortality risk compared to 10.8% in the non-RA population . These patients had an odds ratio and 95% confidence interval of 1.6, 1.2-2.2 for increased CVD mortality after 30-days of an myocardial infarction compared to the non-RA population .
Many of the studies that showed a decrease in CVD mortality in the U.S. were not population-based. In order to confirm an actual decrease in CVD mortality, larger population-based studies with longer follow up are needed. Overall, the data thus far remains robust in support of a current and persistent increased CVD mortality among patients with RA .
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