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
Eat A Mediterranean Diet
No specific diets have been proven to help fight inflammatory arthritis, but theres one eating style worth latching on to. People read about anti-inflammatory diets, says Dr. Gulati. Theyre really describing the Mediterranean diet.
A study of almost 33,000 women found that the more Mediterranean their eating habits were less red meat and more fruits, vegetables, whole grains, fish, legumes, and healthy fats the lower their risk of heart attack, stroke, and heart failure. Focus on replacing saturated fats with heart-healthy unsaturated fats, and eating plenty of fruits, vegetables, and fiber, suggests Dr. Gulati.
How To Protect Your Heart
You can protect your heart by being active, eating a healthy diet, managing stress and working with your doctor to manage RA inflammation and lower your risk for heart disease.
Talk to your doctor about ways to stay physically active with RA and consider consulting with a dietitian to find the best diet to keep inflammation and weight down.
Make sure you know the symptoms that could indicate a problem with your heart. Symptoms such as pain or pressure in your chest or upper body, shortness of breath, lightheadedness, and nausea are signs something isnt right with your heart.
And remember, just because your RA is controlled doesnt mean you shouldnt continue to prioritize your heart health. Continue to work with your doctor to find the best treatment course for you.
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How Arthritis Medication Affect Your Heart
On top of the inflammation from arthritis, certain arthritis medications can also contribute to heart risks, says Martha Gulati, MD, a cardiologist in Phoenix, Arizona.
Corticosteroids like prednisone which are often used to tamp down arthritis flares can raise cholesterol and make insulin less sensitive, both of which contribute to cardiovascular risk. Thats part of the reason rheumatologists try not to keep patients on steroids on a long-term basis.
Whats more, relying on OTC nonsteroidal anti-inflammatory drugs like ibuprofen for pain relief can increase risk of cardiovascular problems like blood clots and heart failure, according to a 2015 analysis by the FDA.
Thankfully, sticking with doctor-recommended biologics and disease-modifying antirheumatic drugs could not only ease your arthritis symptoms, but also protect your heart. Easing the inflammation thats causing arthritis symptoms has the very important bonus of protecting your ticker.
We should treat rheumatoid arthritis very effectively and very aggressively because that seems to reduce the risk of heart disease, says Dr. Loupasakis.
Arthritis And Heart Disease
Learn how having arthritis can affect heart health and what you can do to protect yourself.
Youre probably all too aware of how arthritis affects your joints. But having arthritis osteoarthritis , but especially inflammatory conditions like rheumatoid arthritis , gout, lupus and psoriatic arthritis also puts you at increased risk for heart disease. That includes heart attack, stroke, atrial fibrillation , high blood pressure, heart failure, and atherosclerosis .
Those with gout are also at greater risk for a heart attack or of dying from cardiovascular and coronary heart disease. Gout was linked to a 15% higher risk for heart attack, stroke, or death from heart disease in a 2018 study published in the Journal of the American Heart Association.
People with OA face a 24% higher risk for cardiovascular disease, according to a meta-analysis of 15 studies that included nearly 360,000 people. The authors say shared heart disease risk factors such as high cholesterol and diabetes, along with inactivity and the use of nonsteroidal anti-inflammatory drugs , may be behind the increased risk. Another important contributor to heart disease is inflammation that can come with OA.
Chronic Inflammation and Your Heart
Inflammatory cells get into blood vessel walls where they make cytokines immune system proteins that promote inflammation. Inflammation also reshapes blood-vessel walls, making deposited plaques more prone to rupture. A rupture, in turn, can trigger a heart attack.
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Enough To Give You A Heart Attack
RA has been linked to several kinds of heart problems, including:
. This condition, the most common type of heart rhythm problem, occurs when the upper chambers of the heart beat very fast and irregularly. Left untreated, it can lead to a or heart failure. People with RA have an increased risk of developing atrial fibrillation.
Heart attack. Plaque sometimes builds up inside arteries that supply the heart, narrowing them. The presence of plaque increases the chance that a blood clot will form. If a piece of plaque or a blocks the flow of blood to the heart, the result is a heart attack. The risk of having a heart attack is up to two times higher in people with RA, compared with those without RA.
Heart failure. This condition occurs when the heart is unable to pump enough blood to meet the bodys demands. People with RA are more likely than those without RA to develop heart failure and die soon afterward.
Pericarditis. In this condition, the membrane enclosing the heart becomes inflamed, leading to and sometimes disrupting the hearts normal rhythm. Chronic RA inflammation may cause long-lasting pericarditis.
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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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?
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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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.
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.
What You Can Do
People living with RA should consult their doctor if they experience any new symptoms, want more information on heart health, or want to try out any new supplements or vitamins as a part of their treatment regimen.
The Arthritis Foundation and other experts recommend exercise as part of an overall balanced and healthful lifestyle of wellness for people with arthritis.
There are many health benefits to exercising, even with arthritis, Kindle Fisher, a physical therapist in Pennsylvania, told Healthline.
Exercises such as walking, swimming, or using a stationary bike can increase blood flow and synovial fluid to the joints. Increasing blood flow will also strengthen the heart, she said. While there are severe cases of arthritis where its not always possible to do so, any type of activity can release endorphins, improve health, and help you feel better overall.
People with RA say its important to keep a watch on their heart health but also to try to have a normal life.
I became educated on how unchecked inflammation increases the risk of heart disease, including the risk of heart attack and stroke, Sandra S. of British Columbia, Canada, told Healthline.
William A. of Pittsburgh, Pennsylvania, notes that while cardiovascular risk is a concern, it doesnt consume his life.
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Is There A Link Between Arthritis And Heart Disease
Inflammation is a risk factor for heart disease, so inflammatory conditions like rheumatoid arthritis , gout, lupus and psoriatic arthritis can increase your risk.
Inflammatory cells get into blood vessel walls where they make cytokines immune system proteins that promote inflammation. Inflammation can also reshape blood-vessel walls, making deposited plaques more prone to rupture. A rupture can trigger a heart attack.
The risk isnt limited to people with inflammatory arthritis. Damage from osteoarthritis a disease of the whole joint that leads to the breakdown of joint cartilage and the underlying bone can cause inflammation, which in turn increases the risk of heart disease.
- People with RA face a 50 percent higher risk for cardiovascular disease and are significantly more likely to have a heart attack or be hospitalized for heart failure.
- People with OA face a 24 percent higher risk for cardiovascular disease than the general population.
- Nearly half of all adults with heart disease also have arthritis.
- Nearly 60% of people with arthritis are women.
- 1 in 4 Canadian women and 1 in 6 Canadian men have arthritis.
- While arthritis affects people of all ages, the likelihood increases with age.
Minimize Risk Treat Ra Symptoms
Dr. Husni says clinicians should increase scrutiny of patients with inflammatory arthritis. These patients need aggressive CV risk factor screening and management, she says.
In addition, Dr. Husni stresses the need for more studies going forward. We need further research to help find the optimal coordination of care among the many specialists that care for these patients, she says.
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Limit Exposure To Pesticides Airborne Chemicals And Air Pollution
There seems to be a tight connection between the lungs and joints in RA, so it’s very important to eliminate inhalants, such as pesticides, airborne chemicals, and air pollution, as much as possible. Most of the research has focused on the detrimental effects of cigarette smoking on both the joints and lungs, but it makes sense that the others are likely unhealthy as well, says Sparks.
Keep A Check On The Progression Of Your Disease
RA is a progressive, degenerative disease which over the years can cause severe damage to your various vital organs, including lungs. To prevent the acute damage that RA can cause, it is important to keep a close check on the progression of the disease. So, watch out for all the signs of rheumatoid arthritis and immediately get in touch with your primary care physician if you experience persistent cough, shortness of breath, fever or any other health complication.
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Can Ra Be Fatal
RA alone is not fatal. Fatality occurs due to complications associated with the inflammation caused by RA. In severe cases, patients can develop other medical conditions. The other medical conditions that patients need to be aware when it comes to shortened RA life expectancy include:
- Heart disease
- Respiratory conditions like Chronic Pulmonary Obstruction Disorder
Off course, these are conditions that everyone should be concerned about. Keeping your body healthy through diet, exercise, and positive habits will go a long way to reducing the risk of fatality from any of these conditions.
Limit Your Exposure To Pollutants And Chemicals
There are various chemicals and pollutants in the air that increase the oxidative stress in the body, causing inflammation which, in case of RA, is detrimental both for your joints and lungs. Thats why, patients with RA should limit their exposure to pesticides, airborne chemicals, pollutants and more.
Congestive Heart Failure Ischaemic Heart Disease And Risk Factors
Several reports showed that the increased incidence of cardiovascular disease, including ischaemic heart diseases, or the presence of carotid atherosclerosis is not explained by traditional cardiovascular risk factors , suggesting that RA-related factors might influence the risk of cardiovascular disease .
The increased prevalence of congestive heart failure found in RA patients is underlined by recent echocardiographic studies. Left ventricular systolic dysfunction has been found to be three times more common than in the general population and was associated with abnormal electrocardiography, suggesting that screening of RA patients with abnormal electrocardiography may be worthwhile . Also, right and left ventricular diastolic dysfunction are found more frequently in RA patients without evident cardiovascular disease .
As the use of several drugs in RA, including corticosteroids and biological therapy, have such an important positive effect in the reduction of arthritis activity and improvement of functional capacity, it is important to have more knowledge on possible deleterious effects on the function of the heart due to these drugs.
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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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: