Monday, December 5, 2022

How Does Rheumatoid Arthritis Affect The Heart

Recognizing And Diagnosing Costochondritis

Rheumatoid arthritis – causes, symptoms, diagnosis, treatment, pathology

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.

What Is The Difference

Rheumatoid arthritis vs. osteoarthritis

Rheumatoid arthritis and osteoarthritis are both common causes of pain and stiffness in joints. But they have different causes. In osteoarthritis, inflammation and injury break down your cartilage over time. In rheumatoid arthritis, your immune system attacks the lining of your joints.

Rheumatoid arthritis vs. gout

Rheumatoid arthritis and gout are both painful types of arthritis. Gout symptoms include intense pain, redness, stiffness, swelling and warmth in your big toe or other joints. In gout, uric acid crystals cause inflammation. In rheumatoid arthritis, its your immune system that causes joint damage.

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

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Effects Of Rheumatoid Arthritis On The Cardiovascular System

Rheumatoid arthritis is the most common type of autoimmune arthritis, which causes swelling, stiffness, and pain in the joints. It occurs in more than one area of the body, and the symptoms are often similar, meaning they appear on both sides of the body, such as both knees and both elbows.

Foto: Shutterstock.

The arthritis rheumatoid can become disabling depending on the progression of the disease, especially if treatment is omitted or if physical and pharmacological therapies are inconsistent.

By not being treated in time, this disease can affect different organs of the patient, it is a pathology that can generate different lung conditions where the inflammatory process can develop fibrosis in the lunga very severe and disabling condition that also requires the attention and monitoring of a pulmonary pulmonologist.

In these cases, patients can develop dependence on oxygen for their daily lives, limiting their quality of life. these are patients who walk down a corridor and are already tired. It is a very severe complication that is highly feared and it is one of those we want to avoidstressed in an interview with the Medicine and Public Health magazine, the rheumatology specialist Amarilis de Jesús.

symptomatology

Can Ra Be Fatal

Effects of rheumatoid arthritis on the body

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:

  • 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.

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Can Rheumatoid Arthritis Go Away

No, rheumatoid arthritis doesnt go away. Its a condition youll have for the rest of your life. But you may have periods where you dont notice symptoms. These times of feeling better may come and go.

That said, the damage RA causes in your joints is here to stay. If you dont see a provider for RA treatment, the disease can cause permanent damage to your cartilage and, eventually, your joints. RA can also harm organs like your lung and heart.

A note from Cleveland Clinic

If you have rheumatoid arthritis, you may feel like youre on a lifelong roller coaster of pain and fatigue. Its important to share these feelings and your symptoms with your healthcare provider. Along with X-rays and blood tests, what you say about your quality of life will help inform your treatment. Your healthcare provider will assess your symptoms and recommend the right treatment plan for your needs. Most people can manage rheumatoid arthritis and still do the activities they care about.

Last reviewed by a Cleveland Clinic medical professional on 02/18/2022.

References

Other Bdmards And Tsdmards And Heart Disease

In addition to TNF-, IL-6 represents another proinflammatory cytokine targeted in RA. In the context of the development of major adverse cardiovascular events, the IL-6 receptor inhibitor tocilizumab was shown to be a safe alternative for the TNF- antagonist etanercept.

Abatacept and rituximab represent another class of bDMARDs, which target antigens on the surface of dendritic cells and B cells , respectively. T cell costimulation inhibitor abatacept is prescribed to patients with RA with a worse cardiovascular profile however, it does not affect the risk of developing heart failure compared with etanercept. Rituximab is a humanised chimeric anti-CD20 monoclonal antibody preventing B cell activation. Rituximab was shown to improve vascular pathophysiology in RA. In clinical trials, rituximab showed a cardiovascular safety profile comparable to anti-TNF- treatments.

Some patients with RA receive tsDMARDs JAK inhibitors tofacitinib or baricitinib. Both JAK inhibitors have been shown to worsen the plasma lipid profile however, data from clinical studies and databases do not suggest an increased cardiovascular risk in patients with RA treated with these drugs. It should be mentioned that statins can effectively reverse dyslipidaemia in patients with RA treated with tofacitinib.

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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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Arthritis And Heart Disease

What is Rheumatoid Arthritis? | Johns Hopkins Rheumatology

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 Inflammationand 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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What Are The Risk Factors For Developing Rheumatoid Arthritis

There are several risk factors for developing rheumatoid arthritis. These include:

  • Family history: Youre more likely to develop RA if you have a close relative who also has it.
  • Sex: Women and people designated female at birth are two to three times more likely to develop rheumatoid arthritis.
  • Smoking:Smoking increases a persons risk of rheumatoid arthritis and makes the disease worse.
  • Obesity: Your chances of developing RA are higher if you have obesity.

Whats The Age Of Onset For Rheumatoid Arthritis

RA usually starts to develop between the ages of 30 and 60. But anyone can develop rheumatoid arthritis. In children and young adults usually between the ages of 16 and 40 its called young-onset rheumatoid arthritis . In people who develop symptoms after they turn 60, its called later-onset rheumatoid arthritis .

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Heart Disease Management/outcome In Ra

Patients with RA are typically managed by several physicians, and coordination of care may be suboptimal. Smoking cessation and control of standard risk factors are all indicated in patients with RA, but may be underused because of the understandable focus on management of RA itself. Despite the well understood benefits of exercise on general and cardiovascular health, the majority of patients with RA do not pursue a regular exercise program . Both aerobic and resistance exercise training for patients with RA has been shown to be efficacious in improving overall well being, the muscle mass loss associated with RA, and markedly improving physical function without exacerbating disease activity and is likely to reduce cardiovascular risk, and should be part of routine care .

How Heart Disease Affects People With Ra

How Does Rheumatoid Arthritis Affect the Heart?: A Complication of RA ...

Dr. Navarro-Millán is an advocate for coordinated care, in which people with RA get primary care along with seeing a rheumatologist. She emphasized that primary care doctors and rheumatologists need to stay in close communication when risk factors are identified. As rheumatologists, we are really focused on controlling pain, decreasing inflammation, and decreasing and monitoring side effects of medication, Dr. Navarro-Millán said.

But people with RA need to have regular screenings by primary care providers for cardiovascular disease risk factors like hyperlipidemia high cholesterol and high blood pressure. Many of my patients with rheumatoid arthritis say, Well, I don’t have anything else but rheumatoid arthritis. Why should I see a primary care provider? And that is where things start to fall through the cracks, she noted.

One myRAteam member described her experience discovering heart problems unexpectedly. I am in the hospital with high blood pressure and a high heart rate, she said. I went to see my rheumatologist and she sent me straight to the emergency room. I dont have a history of heart problems or high blood pressure.

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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

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.

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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.

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Subclinical Changes In Hearts Of Patients With Ra

How to Better Manage Your Rheumatoid Arthritis | Access Health

The majority of patients with RA develop no serious cardiac manifestations for many years. Nevertheless, their hearts can show subclinical and asymptomatic changes. Various non-invasive imaging tools provide accurate insight into the structure and function of the cardiovascular system. Technical advantages and limitations of the specific imaging techniques are described elsewhere. Data of cardiac MRI and positron emission tomographycomputed tomography in patients with RA with no diagnosis of cardiovascular disease demonstrated that up to half showed signs of cardiac fibrosis or inflammation. These changes in the myocardium might be responsible for the observed increased left ventricular mass in patients with RA. Although hearts of patients with RA typically show effective pumping, the contractile function is often compromised. Reduced systolic and diastolic left ventricle functions were found in up to 50% of patients with RA without clinical signs of cardiac disease. Furthermore, echocardiography studies revealed that RA is also associated with exceptionally high rates of asymptomatic pericarditis and cardiac valvular involvement.

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Will Changing My Diet Help My Rheumatoid Arthritis

When combined with the treatments and medications your provider recommends, changes in diet may help reduce inflammation and other symptoms of RA. But it wont cure you. You can talk with your doctor about adding good fats and minimizing bad fats, salt and processed carbohydrates. No herbal or nutritional supplements, like collagen, can cure rheumatoid arthritis. These dietary changes are safer and most successful when monitored by your rheumatologist.

But there are lifestyle changes you can make that may help relieve your symptoms. Your rheumatologist may recommend weight loss to reduce stress on inflamed joints.

People with rheumatoid arthritis also have a higher risk of coronary artery disease. High blood cholesterol can respond to changes in diet. A nutritionist can recommend specific foods to eat or avoid to reach a desirable cholesterol level.

What You Can Do

Certain foods, such as seafood, and supplements, like fish oil and essential omega fatty acids, can help with both heart health and the inflammation of arthritis.

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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