Getting To The Heart Of The Rheumatoid Arthritis-Cardiovascular Disease Controversy

I have discussed here more than once the increased risk of death in rheumatoid arthritis patients when compared to healthy individuals. Interestingly, one-third to one-half of premature deaths in rheumatoid arthritis is due to cardiovascular disease; and it appears that inflammation plays a large role in the hardening of the arteries seen in atherosclerosis. A good sense of the magnitude of the role of cardiovascular disease in rheumatoid arthritis is important because inflammation plays such a large role in rheumatoid arthritis.

A recent review of studies which have examined the issue of cardiovascular death rates in rheumatoid arthritis patients set out to fix a number on the degree of the problem. The authors of this study, published in the December 15, 2008 issue of Arthritis and Rheumatism (Arthritis Care and Research), found that there was a 50% increased risk of death from cardiovascular disease compared with the general population. More specifically, the increased death rate was due to more deaths from ischemic heart disease and stroke.

However, these results must be looked at with caution, as the majority of the studies reviewed for this study involved patients before the widespread use of the biologic drugs (such as Enbrel, Humira and Remicade); so, the results found may be quite different compared to the current era when many patients are rather quickly placed on a biologic agent. In fact, recent evidence indicates that the general death rate is NOT different in rheumatoid arthritis patients treated with a biologic drug. Obviously, more studies looking specifically at the cause of death in patients treated with biologic agents would be helpful in further clarifying the situation.

It still would be nice to have an original study, carefully designed, looking into this rheumatoid arthritis-cardiovascular disease connection. For example, those patients who have had rheumatoid arthritis for a shorter time might be younger and have had less years of inflammation, which means less potential damage to the coronary arteries. Also, the more recently enrolled study subjects may not have had an adequate amount of time on an anti-rheumatic drug, to allow such drugs to exert their anti-inflammatory effect on both joints and arteries.

An ideal study would look at the different types of rheumatoid arthritis treatments, the amount of time a patient has been treated with such medications, and, of course, the incidence of stroke or heart disease in that particular group.

Studies show that the risk of death from stroke or heart attack is increased in people who suffer from rheumatoid arthritis when compared with the general population. It follows that physician and patient should pay keen attention to modifying risk factors for cardiovascular disease: education on diet and lifestyle needs to be included in any discussion of arthritis with the rheumatoid arthritis patient.

When the doctor is confronted with a rheumatoid arthritis patient who has, for example, high cholesterol, obesity or a cigarette habit, then it is even more crucial that this health care provider aggressively attempt to lower the cholesterol and weight, and stop the tobacco. Control of joint pain means little if a patient remains on a path to a shortened life span.