Rheumatoid Arthritis and Heart Disease: Shed Light on Dangerous Connection

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Arthritis and heart diseases often occur simultaneously. In fact, a recent study found that arthritis affects 57 percent of adults with heart disease. And in the case of patients with RA, the incidence of heart disease is much higher. RA is actually a separate risk factor for heart disease just like high cholestrol, diabetes and high blood pressure.

People with rheumatoid arthritis and other chronic inflammatory conditions are at higher risk of heart disease. Who is in the most danger, why and how best to prevent and detect cardiovascular complications are important questions for physicians and researchers. Mayo Clinic studies presented at the American College of Rheumatology annual meeting shed new light on this connection, in part by revealing factors that seem to put some rheumatoid arthritis patients in greater jeopardy of heart problems: early menopause, more severe rheumatoid arthritis and immunity to a common virus, cytomegalovirus, among others.

In one study, discovered that patients whose rheumatoid arthritis is more severe are likelier to have heart problems. That becomes true soon after rheumatoid arthritis strikes, making early treatment of rheumatoid arthritis important.

“One thing that we learned in particular in this study is that the high disease burden on the joints in the first year of disease already is a very strong predictor of cardiovascular disease subsequently, and that seems to be mitigated as time goes on if the disease burden can be reduced too,” Dr. Matteson says.

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In other research, a Mayo team looked at a common virus called cytomegalovirus, a bug many people get and do not even know they have. They found correlations between rheumatoid arthritis patients’ immune response to the virus and the development of myocardial disease. If it turns out that there is this relationship, then it may be that one way to spot patients who are at higher risk for heart disease would be an immune profile or biomarkers related to the cytomegalovirus and its associated immune activation signaling,” says Dr. Matteson, a co-author.

Cardiovascular features in rheumatoid arthritis (RA) are common. Among those are the classical extra-articular features that not only include pericarditis, cardiomyopathy/myocarditis, cardiac amyloidosis, coronary vasculitis, arrythmia and valve diseases, but also congestive heart failure and ischaemic heart disease which are found more frequently and are associated with an increased mortality compared with the general population. This overview discusses the epidemiological aspects of these cardiovascular diseases and their relevance for diagnosis and treatment of RA.

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Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints, and extra-articular features may also develop. Joint pain, swelling and limited mobility of the joint are the most prominent features. The disease course varies greatly between patients. Some patients have a mild disease course although in the majority of patients, the disease leads to progressive joint destruction and disability. Besides articular symptoms, RA can be associated with extra-articular features.

Another study found that women with rheumatoid arthritis and early menopause — menopause before age 45 — also seem to be at higher risk of heart disease. About two-thirds of patients with rheumatoid arthritis are women, and researchers have long studied possible hormonal influences on development of the disease, Dr. Matteson says.

“This study shows the complex relationship between rheumatoid arthritis, hormones and heart disease,” says Dr. Matteson, the senior author. “We also found patients who have had multiple children, especially seven or more, are at higher risk of cardiovascular disease compared with women who have menopause at a normal age or have fewer children.”

If you have rheumatoid arthritis (RA), you also have double the risk for heart disease and heart attack.

Rheumatoid arthritis causes inflammation, pain, and swelling of joints. Persistent inflammation over time can damage affected joints. The severity can vary from mild to severe. Treatments include disease-modifying medicines to suppress inflammation, which can prevent or delay the progression of the disease, and medication to ease pain. The earlier treatment is started, the less joint damage is likely to occur. Surgery is needed in some cases if a joint becomes badly damaged.

RA is thought to be an autoimmune disease. The immune system normally makes antibodies (small proteins) to attack bacteria, viruses, and other germs. In people with autoimmune diseases, the immune system makes antibodies against tissues of the body. It is not clear why this happens. Some people have a tendency to develop autoimmune diseases. In such people, something might trigger the immune system to attack the body’s own tissues. The trigger is not known.

In people with RA, antibodies are formed against the synovium (the tissue that surrounds each joint). This causes inflammation in and around affected joints. Over time, the inflammation can damage the joint, the cartilage, and parts of the bone near to the joint.

These are known as extra-articular symptoms of RA (meaning outside of the joints). A variety of symptoms may occur. The cause of some of these is not fully understood:

  • Small painless lumps (nodules) develop in about 1 in 4 cases. These commonly occur on the skin over the elbows and forearms, but usually do no harm.
  • Inflammation around tendons may occur. This is because the tissue which covers tendons is similar to the synovium around the joints.
  • Anaemia and tiredness are common.
  • A fever, feeling unwell, weight loss, and muscle aches and pains sometimes occur.
  • In a few cases, inflammation develops in other parts of the body, such as the lungs, heart, blood vessels, or eyes. This is uncommon but, if it occurs, can cause various symptoms and problems which are sometimes serious.

If your doctor suspects that you have RA, you will usually be referred to a joint specialist (a rheumatologist). This is to confirm the diagnosis and to advise on treatment. It is very important to start treatment as early as possible after symptoms begin. This is because any joint damage done by the disease is permanent. Therefore, it is vital to start treatment as early as possible to minimise or even prevent any permanent joint damage.

 

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