Does Rheumatoid Arthritis Affect Your Heart?
It is well known that rheumatoid arthritis is an auto-immune disease that primarily affects joints. When the immune system attacks the lining of the membranes around the joints, called synovium, and initiates inflammation, the synovium begins to thicken, eventually damaging the cartilage and the bone.
However, the process doesn’t stop there. The inflammation can spread to all the systems in the body, such as the skin, lungs, eyes and heart, including coronary arteries that supply blood to the heart. The inflammation can damage the endothelial cells that line the inside of arteries, promoting the development of atherosclerosis, which consequently narrows the arteries, raising blood pressure and restricting blood flow to the heart.
Thus, cardiovascular risk factors for those suffering from rheumatoid arthritis are:
Heart attack. Besides faster progression of atherosclerosis in people with rheumatoid arthritis, the inflammation can reshape the blood vessel walls, making the deposited plaque unstable and more prone to rupture. A rupture, in its turn, can result in myocardial infarction.
Pericarditis. When the membranes enclosing the heart, known as pericardium, become inflamed, they begin to rub against each other, causing intense chest pain and sometimes disrupting the heart’s normal rhythm. Chronic inflammation due to rheumatoid arthritis may result in long-lasting pericarditis.
Atrial fibrillation. People with rheumatoid arthritis have a higher risk of developing atrial fibrillation – a heart rhythm problem, where the upper chambers of the heart beat faster and irregularly. If left unattended, this can lead to heart failure and stroke.
Heart failure. When rheumatoid arthritis is present, the patients are more likely to develop heart failure – when the heart becomes unable to pump enough blood to meet the body’s demands.
Pulmonary embolism. The inflammation can affect veins, too, increasing the risk of deep vein thrombosis and pulmonary embolism – blood clots in legs and lungs. The latter can cause shortness of breath, chest pain upon breathing, lightheadedness and coughing up blood.
Overall, the more severe rheumatoid arthritis is, the greater are the chances of developing a heart disease.1
However, women are relatively protected against heart problems if they haven’t reached menopause yet. But, this sex-gap narrows after menopause.2 Moreover, the risk of cardiovascular disease in women is higher when a woman goes through early menopause. This is due to protective effects of estrogen, which decreases after menopause.
That’s why it is especially important to take care of your heart if you have rheumatoid arthritis and necessary to get the inflammatory arthritis under control in order to have the less systemic inflammation possible. Although, ironically, certain medications for arthritis can negatively affect the heart.3 For example,
Corticosteroids can cause weight gain, raise blood pressure and elevate heart disease risk, especially when administered in high doses;
NSAIDs can interfere with the body’s ability to keep blood vessels open, thus elevating the risk of stroke, atrial fibrillation and heart attack.
Methotrexate can cause endothelial damage and promote hyperhomocysteinemia.
Luckily, other therapies that have a more favorable effect on the body, like TNF inhibitors, are available. Talk to your doctor whether your medications and doses are right for you. Otherwise, they may prescribe other drugs to tame inflammation and heart disease as well.
References:
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Cynthia S Crowson, Katherine P Liao, et.al. “Rheumatoid Arthritis and Cardiovascular Disease” American Heart Journal. 166(4): 622–628.e1. Published online: August 29, 2013. https://doi.org/10.1016/j.ahj.2013.07.010
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Mariana Garcia, Sharon L. Mulvagh, et.al. “Cardiovascular Disease in Women: Clinical Perspectives” Circulation Research. 118(8): 1273–1293. Published online: April 15, 2016. https://doi.org/10.1161/CIRCRESAHA.116.307547
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Mariana J. Kaplan. “Cardiovascular complications of Rheumatoid Arthritis - Assessment, prevention and treatment” Rheumatic Disease Clinics of North America. 36(2): 405–426. Published online: May, 2010. https://doi.org/10.1016/j.rdc.2010.02.002
