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Can Rheumatoid Arthritis Cause High Blood Pressure

What Can Cause Gouty Arthritis

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Inflammation Harms Your Heart And Vessels

Rheumatoid arthritis is, at its core, an inflammatory disorder. Your immune system mistakenly identifies healthy tissue around your joints as an invader and attacks it. That attack causes inflammation and the pain, swelling, and warmth that go along with it. But the inflammation, unfortunately, isnt just limited to your joints. It can circulate throughout your entire body and damage other tissues, including those in your blood vessels and heart.

Inflammation irritates blood vessels throughout your body. It makes plaque more likely to form and also makes plaque less stable. This means that it is more apt to break off, form a clot, and block an artery that leads to your brain or your heart . It also makes you more prone to blood clots in the deep veins of your legs , which can travel to your lungs and cause a pulmonary embolism.

Additionally, inflammation causes LDL cholesterol to oxidize, or become chemically changed. Oxidized LDL can more easily slip under the lining of coronary vessels and get trapped there, where it causes even more inflammation, says Dr. Karpouzas.

This is more likely to occur in RA patients with high disease activity than it is among those whose disease is in remission.

Dont Assume Blood Pressure Is Normal If Its Not Discussed

A study published in April 2016 in the journal Arthritis Care Research,which was led by Bartels, found that many patients assumed their blood pressure was normal if it was not mentioned. Rheumatologists said they might not address blood pressure or would just send a note, assuming primary care would manage it.

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What Are The Signs And Symptoms Of Ra

With RA, there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.

Signs and symptoms of RA include:

  • Pain or aching in more than one joint
  • Stiffness in more than one joint
  • Tenderness and swelling in more than one joint
  • The same symptoms on both sides of the body
  • Weight loss

The Connection Between Ra And High Blood Pressure

10 Complications of Rheumatoid Arthritis

RA is usually diagnosed after symptoms like swelling and discomfort in joints become so painful that the person seeks medical or specialized rheumatology care. High blood pressure, however, may not produce obvious or noticeable symptoms.

Blood pressure is usually tested at regular doctors appointments. The reading is in millimeters of mercury and provides two numbers:

  • Systolic blood pressure Measures blood pressure in your arteries when your heart beats
  • Diastolic blood pressure Measures blood pressure in your arteries when your heart is at rest

Sometimes, people are diagnosed with high blood pressure shortly after getting diagnosed with RA. Several factors may be responsible for the connection between high blood pressure and RA. Inflammation, RA medications, and physical inactivity due to RA are thought to play a part in this relationship.

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Your Doctor Might Not Be Keeping Tabs On Your Cardiovascular Health

A large number of RA patients dont even get a cholesterol test, says Dr. Navarro-Millan. The problem, she says, is that many patients treat their rheumatologist as their main health care provider, but rheumatologists expect that primary care physicians, such as internists, are monitoring their patients heart health.

In the CreakyJoints survey, 20 percent of respondents said they were not monitoring their heart health with a doctor, such as getting regular cholesterol or blood pressure tests.

Rheumatologist Jeffrey Curtis, MD, MPH, Professor of Medicine at the University of Alabama at Birmingham, says that physician ownership or lack thereof is a huge problem when it comes to RA and co-occurring conditions like heart disease. There are some blurry domains in medicine for people with chronic medical conditions, he says. Many rheumatologists might say, My job is to take care of your RA. They may not have time to manage issues like high blood pressure, high cholesterol, diabetes, and other heart disease risk factors.

This disconnect means that the responsibility can fall on RA patients in a few ways. Not only is it essential to see a primary care doctor , but its important to bring up heart health with your rheumatologist.

Its too easy for, say, a nurse to take a blood pressure measurement, enter it into a patients health record, and then nothing else happens. Dont assume your doctor would tell you if there was a problem, Dr. Bartels says.

Rheumatoid Arthritis Blood Tests

The rheumatoid arthritis blood tests that doctors perform to help diagnose the disease include:

  • Rheumatoid factor
  • C-Reactive Protein
  • Antinuclear Antibody

None of these tests can singularly conclude that a patient has rheumatoid arthritis. Rather, doctors look at the combined results from all, alongside a number of other criteria including physical symptoms and genetics, in order to reach a rheumatoid arthritis diagnosis.

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Methotrexate Blood Pressure And Arterial Function In Rheumatoid Arthritis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government.Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
First Posted : August 18, 2017Last Update Posted : February 3, 2021
Condition or disease
Rheumatoid ArthritisStiffness, AorticEndothelial DysfunctionCardiovascular Risk Factor Drug: MethotrexateDrug: SulfasalazineDrug: Other DMARDs Phase 4

Patients with rheumatoid arthritis have an increased risk of stroke and heart attack when compared to the rest of the population. Recent studies have shown that methotrexate, a disease-modifying antirheumatic drug commonly prescribed for rheumatoid arthritis, reduces this risk. However, the mechanisms responsible for the protective effects of methotrexate on the heart and the brain are unknown.

Each participant will attend three study visits , each lasting between 60 and 90 min.

  • Pregnancy, currently trying to become pregnant, or of child bearing potential and not using birth control.
  • Significant illness within 2 weeks of study start.
  • Patients with an unstable active medical condition that could impair evaluation of study results.

Review Medications With A Doctor

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Some medications for PsA may reduce the risk of heart disease, while others may increase it.

For example, steroids can raise cholesterol levels and cause the body to become less sensitive to insulin. In turn, this can contribute to the risk of cardiovascular disease.

Conversely, biologics and disease-modifying antirheumatic drugs can not only ease pain in the joints but also protect the heart.

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The Temporal Relationship Between Arterial Stiffening And Blood Pressure Is Modified By Methotrexate Treatment In Patients With Rheumatoid Arthritis

  • 1Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, SA, Australia
  • 2Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Adelaide, SA, Australia
  • 3Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
  • 4Department of Rheumatology, Flinders University and Southern Adelaide Local Health Network, Adelaide, SA, Australia

Background: The temporal relationship between arterial stiffness and blood pressure may vary depending on age and other clinical and demographic factors. Since both BP and arterial stiffness are also affected by inflammatory processes, we examined the temporal arterial stiffness-BP relationship in patients with rheumatoid arthritis treated with either methotrexate , an anti-rheumatic agent shown to reduce cardiovascular risk in meta-analyses, or other disease-modifying anti-rheumatic drugs .

Methods: Measurements of clinic and 24-h peripheral and central systolic and diastolic BP , and pulse wave velocity were assessed in RA patients on stable treatment with either MTX ± other DMARDs or other DMARDs . Measurements were performed at baseline and after 8 months. The temporal relationships were examined using cross-lagged path analysis with models that included age, sex, body mass index, prednisolone, and folic acid use and 28-joint disease activity score.

What The New Blood Pressure Guidelines Mean For Rheumatoid Arthritis

Hypertension guidelines released at the end of 2017 redefine high blood pressure as 130/80 mmHg or higher. Several aspects of the new guidelines are especially important for people living with rheumatoid arthritis .

Because RA poses higher risk of cardiovascular disease and people with RA are less likely to be diagnosed with hypertension even if symptomatic, they should heed the guidelines, said Christie Bartels, MD, MS, assistant professor, Rheumatology.

“Research shows you can reduce your risk of stroke if you can get down to 130/80,” said Dr. Bartels.

Keeping your primary care physician in the loop is important, emphasizes Dr. Bartels. “Patients may have gaps in preventive care. If three-quarters of their of visits are in a rheumatology clinic, the primary care physician might not be aware that levels have been elevated over time, and rheumatologists may not have blood pressure on their radar, she said.

And no news about blood pressure does not necessarily translate to good news. “If the nurse doesnt tell you what your numbers are, ask. Dont assume its normal its not always the case. Its important to be an empowered patient so you can follow up,” said Dr. Bartels.

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Who Is Affected By Gout

Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs after menopause in women. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.

People are more likely to get gout if they have:

  • Obesity, or a lot of extra weight.

You are also more likely to develop gout if you:

  • Consume a diet high in animal proteins
  • Consume a significant amount of alcohol
  • Are on water pills .

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Top Blood Pressure Facts For People Living With Rheumatoid Arthritis

High Blood Pressure, Diagnosis, Symptoms, Treatment Options, Stem Cell ...

Fact: People with RA are at heightened risk for cardiovascular disease .

Fact: If you have RA, you actually have less of a chance of being diagnosed with high blood pressure even if you have all the signs.

Fact: Within the new, stricter guidelines, even more people with RA are at risk for cardiovascular events, making it even more important that you and your healthcare team assess your blood pressure and manage it if it’s too high.

Related: Is Rheumatoid Arthritis Hiding Your High Blood Pressure?

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Study Endpoints Power Sample Size And Statistical Analysis

Clinic peripheral SBP was the primary study endpoint. Clinic peripheral DBP, central BP, AIx, ADMA, 24-hour peripheral and central BP and PWV were secondary endpoints. Based on previous reports of a 3 mmHg SBP difference between patients treated with MTX versus other DMARDs in observational studies,22 the initial target sample size consisted of 400 patients in total, assuming a standard deviation of 14 mmHg and a correlation between repeat measures of r = 0.65. However, this was re-calculated after a preliminary analysis of the baseline BP data after approximately 30 patients showed larger differences in SBP. The revised sample size of 86 patients in total had more than 80% power to detect a difference of 7 mmHg in SBP between the MTX and non-MTX groups.

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 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 for suggestions on making lifestyle changes successfully.

, unhealthy cholesterol levels, and 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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Does Treating/controlling Psa Reduce Heart Disease Risk

It makes sense that treating your psoriatic arthritis to keep heart-damaging inflammation at bay would reduce heart disease risk, although researchers are continuing to study this very question.

One observational study published this year in the journal Cardiovascular Research looked at 215 psoriasis patients with low cardiovascular risk. Some were on a biologic, while others opted not to be. After a year of follow-up, those who were on biologic treatment were found to have a 6 percent reduction in arterial plaque, likely because of a reduction in underlying inflammation.

We do think treating a psoriatic condition will reduce the risk of heart disease, but we dont know that yet, says Dr. Garshick. However, there are multiple other reasons to treat your PsA.

That said, just because your PsA may be well controlled say, in terms of minimal flares does not mean you can assume everything is fine regarding your heart health. You still should be assessed for additional heart disease risk factors and practice healthy preventive lifestyle habits, he says.

Ra Patients Experienced Higher Systolic Blood Pressure Variability

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Patients with rheumatoid arthritis displayed greater fluctuations in systolic blood pressure compared with patients without rheumatoid arthritis, increasing their cardiovascular and mortality risk, according to research presented at the annual congress of the European League Against Rheumatism in Madrid.

Cardiovascular disease was more likely to occur in patients with rheumatoid arthritis and more unstable systolic blood pressure, researcher Eric L. Matteson, MD, rheumatology chair at Mayo Clinic, Rochester, Minn., said in a press release. Doctors should be particularly careful to manage cardiovascular risk.

Eric L. Matteson

Matteson and colleagues studied 452 patients with rheumatoid arthritis and 436 patients without RA . Within-subject standard deviation in systolic and diastolic blood pressure was used to define BP variability in patient data collected from the National Institutes of Health-funded Rochester Epidemiology Project.

There were 13,470 BP measures in the RA cohort and 9,476 in the non-RA cohort during a mean follow-up of 7.1 ± 2.7 years and 7.2 ± 2.6 years, respectively. RA patients BP was measured less frequently than the non-RA cohort .

Mean systolic BP at RA incidence/index rate for RA patients was 131.2 ± 18.7 mm Hg compared with 128.2 ± 19.3 mm Hg for non-RA patients , while the mean diastolic BP was similar between cohorts.

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Study Population And Design

We studied a consecutive series of patients with stable RA, aged 18 years, recruited from the outpatient clinics of the Rheumatology Department at Flinders Medical Centre and the Repatriation General Hospital, in the Southern Health Local Heath Network, Adelaide, Australia. RA was diagnosed according to the 1987 American College of Rheumatology or the 2010 American College of Rheumatology/European League Against Rheumatism criteria.24 Study participants were classified as currently treated with MTX for at least 8 weeks , or not taking MTX for at least 1 year or being MTX-naïve and treated with other synthetic and/or biologic DMARDs . Exclusion criteria were atrial fibrillation, active cancer or current treatment with anti-cancer drugs, heart failure and cognitive impairment. The study was approved by the Southern Adelaide Clinical Human Research Ethics Committee . Each participant gave written consent before entering the study.

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 heart’s 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.

Rheumatoid arthritis can make you more likely to get cardiovascular disease. It also raises your risk of stroke. This is probably related to long-term inflammation.

Heart disease doesn’t 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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What Are The Risk Factors For Ra

Researchers have studied a number of genetic and environmental factors to determine if they change persons risk of developing RA.

Characteristics that increase risk

  • Age. RA can begin at any age, but the likelihood increases with age. The onset of RA is highest among adults in their sixties.
  • Sex. New cases of RA are typically two-to-three times higher in women than men.
  • Genetics/inherited traits. People born with specific genes are more likely to develop RA. These genes, called HLA class II genotypes, can also make your arthritis worse. The risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese.
  • Smoking. Multiple studies show that cigarette smoking increases a persons risk of developing RA and can make the disease worse.
  • History of live births. Women who have never given birth may be at greater risk of developing RA.
  • Early Life Exposures. Some early life exposures may increase risk of developing RA in adulthood. For example, one study found that children whose mothers smoked had double the risk of developing RA as adults. Children of lower income parents are at increased risk of developing RA as adults.
  • Obesity. Being obese can increase the risk of developing RA. Studies examining the role of obesity also found that the more overweight a person was, the higher his or her risk of developing RA became.

Characteristics that can decrease risk

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