As if the chronic pain and mobility challenges of rheumatoid arthritis weren’t burdensome enough, it’s becoming clearer that people with the disease face another serious health threat—a greater risk for heart disease.
Some 1.5 million Americans, a majority of them women, have this form of arthritis, an autoimmune disease that happens when the immune system attacks the body’s own tissues, causing pain, swelling, stiffness and loss of function in the joints.
Doctors have long known that people with rheumatoid arthritis and related conditions had a shorter lifespan than those without these conditions. Data suggest that heart disease may explain this discrepancy. In fact a review of studies in the journal Nature Reviews Rheumatology suggests that more than 50 percent of premature deaths in patients with rheumatoid arthritis result from cardiovascular conditions.
The link between the two diseases: inflammation. In people with rheumatoid arthritis, the immune system attacks the synovium—the lining of the membranes around the joints. This causes the synovium to thicken, eventually damaging the cartilage and bone.
But the process doesn’t stop at the joints. The inflammation can damage systems throughout the body, including the skin, eyes, lungs, and heart. Inflammation narrows the arteries, raising blood pressure and reducing blood flow to the heart, for instance.
No wonder people with rheumatoid arthritis have a 50 percent higher risk of experiencing a heart attack, twice the rate of heart failure and more peripheral vascular disease than those without the condition. In fact, research shows, the heart risks of rheumatoid arthritis are on par with those associated with diabetes. The story is similar for gout, lupus and psoriatic arthritis.
Ironically some of the medications that help patients manage their rheumatoid arthritis, such as prednisone, increase the risk of cardiac woes. While prednisone is often relied on to quell out-of-control inflammation, it may do so at a cost, including a greater build-up of plaque on artery walls, stiffer arteries, decreased insulin sensitivity, and higher blood pressure and cholesterol levels. Tocilizumab, an immunosuppressive drug, raises cholesterol levels. And NSAIDs, which are used to control pain and inflammation, may interfere with the body’s ability to keep blood vessels open.
Luckily other therapies, including tumor necrosis factor (TNF) inhibitors (Remicade; Humira; Enbrel), have a more favorable effect on the body, taming inflammation as well as heart disease. A study supported by the National Institutes of Health is currently examining whether methotrexate, another arthritis treatment, may actually lower heart disease risks.
The data suggest that rheumatoid arthritis patients and their doctors should be particularly alert to heart disease risk factors, such as smoking, diabetes, high cholesterol and high blood pressure, keeping in mind that the severity of joint symptoms during the first year is a strong predictor of heart disease.
Physicians should consider conducting a more indepth individualized cardiovascular risk assessment in rheumatoid arthritis patients if not done previously. Cleveland HeartLab’s inflammation tests can help practitioners identify risk early by looking for signs of the presence of subclinical disease or an active cardiovascular disease process. See the Know Your Risk Program™ for more information. Early detection and treatment of heart-related risks could make all the difference in living a long, healthy life.