Risks of Aortic Stenosis in Rheumatoid Arthritis

Introduction

Rheumatoid arthritis is a chronic autoimmune disorder mainly affecting the joints and bones. However, current studies have stated the associated link between rheumatoid arthritis and the development of aortic stenosis. It is a condition characterized by the narrowing of the aortic valves.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis is a systemic autoimmune disease observed in approximately 1 percent of the global population. It primarily affects the joints, causing pain and inflammation. Rheumatoid arthritis is characterized by the immune system attacking the synovium - the lining of the membrane that is present around the joints. This problem can lead to permanent deformability if it is left untreated. Rheumatoid arthritis can also lead to systemic effects like affecting other organs and systems.

What Is Aortic Stenosis?

Aortic stenosis is a cardiovascular condition characterized by the narrowing of the aortic valve. The aortic valve plays an important role in regulating blood flow from the heart to the rest of the body. When this valve becomes constricted or narrowed, it can lead to various complications, impacting overall cardiac health function and potentially leading to life-threatening risks.

What Is the Link Associated with Rheumatoid Arthritis and Aortic Stenosis?

Researchers have shown their interest in establishing the link between rheumatoid arthritis and aortic stenosis. Some studies have stated a higher prevalence of aortic stenosis in patients with rheumatoid arthritis compared to the general population. Still, the exact mechanism has not been fully discovered. But some common risk factors are associated with aortic stenosis and rheumatoid arthritis -

Inflammatory Pathways -

Inflammation is considered a common risk factor for rheumatoid arthritis and aortic stenosis. In rheumatoid arthritis, chronic inflammation plays a significant role in causing joint inflammation and systemic complications. Meanwhile, in aortic stenosis, inflammation leads to the calcification of the aortic values, resulting in the narrowing of values. The inflammatory processes in rheumatoid arthritis might contribute to the development of atherosclerosis and calcific changes in the aortic valve, promoting the progression of aortic stenosis.

Some Common Risk Factors -

It is believed that there are some common risk factors associated with rheumatoid arthritis and aortic stenosis. Risk factors include cardiovascular risk factors, such as hypertension, dyslipidemia (unhealthy fat levels), consumption of alcohol, and smoking, are common in both conditions. There may be a genetic predisposition that makes certain individuals susceptible to both rheumatoid arthritis and aortic stenosis.

Impact of Certain Medications -

The indicated medicine to treat rheumatoid arthritis can also result in aortic stenosis. Knowing the associated risk, there are certain disease-modifying antirheumatic drugs (DMARDs) that may have protective cardiovascular effects, while some drugs may potentially increase the risk. It is very important to understand the link between rheumatoid arthritis medications and the development of aortic stenosis before opting for the treatment to minimize the associated risk.

Atherosclerosis as a Common Pathway -

Atherosclerosis, the buildup of plaques in arteries, is a common pathway in both rheumatoid arthritis and aortic stenosis. Chronic inflammation in rheumatoid arthritis may contribute to the development of atherosclerosis, affecting not only the joints but also the cardiovascular system.

Autoimmune Responses: The autoimmune nature of rheumatoid arthritis suggests an overactive immune system that can lead to autoimmune responses affecting various organs. These immune responses may contribute to the processes leading to aortic stenosis, although the specific mechanisms are still being explored.

What Is the Diagnosis of Aortic Stenosis in Rheumatoid Arthritis?

The following are investigations indicated for the diagnosis of aortic stenosis in rheumatoid arthritis-

1. Clinical Assessment:

• A thorough clinical evaluation is very important. Symptoms of aortic stenosis may include chest pain, shortness of breath, fatigue, and dizziness.

• Evaluate the patient's rheumatoid arthritis symptoms, disease activity, and the impact of rheumatoid arthritis medications.

2. Cardiovascular Imaging:

• Echocardiography: This imaging test provides detailed images of the aortic valve, helping assess the severity of stenosis and its impact on cardiac function.

• Cardiac Magnetic Resonance Imaging (MRI): In some cases, cardiac MRI is indicated to offer additional insights, especially in assessing the anatomy and function of the heart.

3. Electrocardiography (ECG) and Other Tests:

• Electrocardiography can reveal signs of left ventricular hypertrophy and other abnormalities associated with aortic stenosis.

• Additional tests, such as stress testing, may be employed to assess the functional impact of aortic stenosis.

4. Biomarkers:

• Elevated levels of certain biomarkers, such as B-type natriuretic peptide (BNP) and troponin, may indicate the severity of aortic stenosis and its impact on the heart.

What Is the Management of Aortic Stenosis in Rheumatoid Arthritis?

The following are ways to manage aortic stenosis in rheumatoid arthritis -

1. Rheumatoid Arthritis Management:

• Disease-Modifying Antirheumatic Drugs (DMARDs): Rheumatoid Arthritis treatment is done to control inflammation. Consider medications with potential cardiovascular benefits.

• Regular Monitoring: Regular assessment of rheumatoid arthritis is essential. This helps to make some necessary adjustments to treatment plans based on the patient's overall health.

2. Aortic Stenosis Treatment:

• Medical Management: Symptomatic relief can be achieved through medications. Diuretics may help manage fluid retention, and beta-blockers can reduce cardiac workload.

• Surgical Aortic Valve Replacement (SAVR): In severe cases, especially when symptoms are pronounced, SAVR is often the treatment of choice. Collaboration between rheumatologists and cardiologists is crucial in the preoperative and postoperative phases.

• Transcatheter Aortic Valve Replacement (TAVR): For high-risk or elderly patients, TAVR may be a suitable alternative to SAVR. Assess the patient's overall health and the potential impact on rheumatoid arthritis management.

3. Multidisciplinary Care:

• Collaboration Between Specialists: A multidisciplinary approach involving rheumatologists, cardiologists, and potentially cardiothoracic surgeons is essential. Regular communication ensures coordinated care for both conditions.

• Patient Education: Empower patients with knowledge about their conditions, the importance of medication adherence, and lifestyle modifications.

4. Cardiovascular Risk Factor Management:

• Hypertension, Dyslipidemia, and Smoking Cessation: Address modifiable cardiovascular risk factors shared by rheumatoid arthritis and aortic stenosis. Encourage lifestyle modifications and appropriate pharmacological interventions.

5. Regular Follow-Up:

• Monitoring Rheumatoid Activity: Frequent follow-ups are necessary to monitor rheumatoid arthritis disease activity and adjust medications as needed.

• Cardiovascular Surveillance: Regular echocardiographic assessments are crucial to monitor the progression of aortic stenosis and guide treatment decisions.

Conclusion

The link between rheumatoid arthritis and aortic stenosis adds complexity to the understanding of autoimmune diseases and heart health. While figuring out the exact reasons, it seems that inflammation, common risk factors, and medication effects are all involved. Recognizing this link is important for healthcare providers to proactively screen, monitor, and manage at-risk patients, enhancing care for those with rheumatoid arthritis.