May is Arthritis Awareness Month and I want to discuss the connection between rheumatoid arthritis and heart disease. If you live with rheumatoid arthritis it is even more important for you to be aware of your heart disease risks and take preventive action.

I've had the pleasure of working with Lene Andersen this month. Lene is the Community Leader for the MyRACentral.com site and took the time to answer a few questions related to rheumatoid arthritis I'd like to share with you.

Lisa Nelson RD: What is rheumatoid arthritis?

Lene Andersen: Rheumatoid arthritis (RA) is an autoimmune disease. In autoimmune diseases the person's immune system doesn't work quite right and attacks itself. With RA, this means inflammation in the synovial fluid surrounding the joints and can lead to damage in the joints, which causes deformity and possibly affect long-term mobility. Inflammation can also affect tendons and muscles and - much more rarely - internal organs. For more information, see MyRACentral's section on the basics of RA.

Recent development in treatment approaches has led to a significant change in the prognosis of RA. The biologic medications - such as Enbrel, Humira and Orencia - now makes it more possible to bring the disease into remission, which means less damage and deformity.

Lisa Nelson RD: How is rheumatoid arthritis linked to heart disease?

Lene Andersen: RA is associated with a "mortality gap," meaning that historically, people who have RA on average have died sooner than the rest of the population. This is primarily due to an increase in ischemic heart disease and hypertension (high blood pressure). Inflammation appears to be a factor in hardening of the arteries, which may explain this phenomenon. As well, some of the medications prescribed for RA - steroids and NSAIDs (onsteroidal anti-inflammatory drugs) - may carry a higher risk of hypertension and heart disease. For instance, in 2004 the anti-inflammatory Vioxx was recalled due to side effects causing a significant increase in heart attack and stroke.

In addition to the increased risk of heart disease, there are a few other factors that contributed to the mortality gap. People with RA who have heart disease may experience different symptoms than the rest of the population, making it more difficult to diagnose and they also tend to have poorer outcomes after a cardiac event. In addition, people with RA do not receive optimal health maintenance and preventative care services. I'm not sure why this is, although I can speculate that it may be related to preventative care being drowned out by RA-related issues. In other words, the medical team may be so busy focusing on treating inflammation and pain that more routine preventative care falls by the wayside.

Recent studies indicate that the biologic medications also affect heart health, significantly improving cardiac health and decreasing the mortality gap.

Lisa Nelson RD: Let me share some standard guidelines for preventative heart care.