Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis and affects roughly 2 million Americans. It is a chronic systemic, autoimmune-driven condition for which there is no known cure to date.
Nonetheless, if diagnosed early and treated aggressively, it can be put into remission.
One of the biggest risks attached to RA is cardiovascular events, namely heart attacks and stroke. In fact, studies have shown that fifty per cent of premature deaths in patients with RA come from cardiovascular events.
The primary culprit is chronic inflammation. The abnormal immune cells responsible for inflammation in RA produce cytokines, protein messengers that promote and aggravate inflammation. Cytokines recruit other inflammatory cells and therefore lead to magnification of the inflammatory response.
Inflammation affects blood vessel walls making plaque that has already deposited more likely to block the blood vessel. If this occurs in an artery in the heart or brain, the consequences can be devastating.
Other co-morbid conditions (other medical conditions a patient may have) can worsen this scenario.
Examples are diseases such as hypertension, elevated cholesterol, smoking, and diabetes that add to the damage already caused by the chronic inflammation of RA.
In particular, smoking is a huge risk additive risk factor. It raises blood pressure, lowers HDL ("good") cholesterol, increases insulin resistance, and by its effect on the lungs, makes it more difficult for patients to exercise.
Two studies illustrate this risk. One study from Johns Hopkins looked at 158 patients with RA and found that 70% of them already had plaque in their carotid arteries (the major arteries that lead to the brain.)
Another study from the Mayo Clinic demonstrated that RA patients are twice as likely to have congestive heart failure compared to people without RA.
Medications taken for arthritis may also play a role in cardiovascular risk.
For example, prednisone, even though it reduces inflammation also can elevate blood pressure and cause weight gain. There is evidence that higher doses of prednisone can increase cardiovascular risk.
Non-steroidal anti-inflammatory drugs (NSAIDS) increase the likelihood of both heart attack and stroke.
Actemra, a biologic drug, increases cholesterol levels. Theoretically, then, this increases cardiovascular risk.
However, all is not lost. There is data suggesting that methotrexate, the workhorse disease-modifying anti-rheumatic drug and biologic therapies such as tumor necrosis inhibitors can actually lower the cardiovascular risk in RA patients.
Things to do: understand the increased risk, don't smoke, exercise regularly, maintain ideal weight (there is evidence that adipose tissue [fat] produces inflammatory cytokines that can aggravate arthritis) and have co-morbid conditions addressed.
Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis Treatment Center http://www.arthritistreatmentcenter.com. He is a former Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: http://www.arthritis-treatment-and-relief.com
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