Can rheumatoid arthritis increase my risk of heart disease?

Question

Hello doctor,

I have had rheumatoid arthritis for 12 years, with painful and swollen joints in my hands, wrists, and knees. I am now experiencing chest pain and shortness of breath. My doctor says that people with rheumatoid arthritis are at high risk for heart disease and that I might have heart problems due to inflammation.

Does rheumatoid arthritis cause heart disease?
What tests do I need?
What can be done to manage both joint and heart health?
Should blood pressure medications be taken?
What about steroids? Are they harmful to the heart?
Should exercise be done, or will it worsen joint and heart problems?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Rheumatoid arthritis (RA) can affect the heart in multiple ways, mainly due to chronic inflammation. It can involve the coronary arteries by causing vasculitis (inflammation of blood vessels) and aorto-ostial disease (narrowing at the origin of the coronary arteries). This increases the risk of blockages and coronary artery disease.

Rheumatoid arthritis may also lead to valvular heart disease, such as mitral and aortic regurgitation (leakage of heart valves). During disease flare-ups, the pericardium (covering of the heart) may become inflamed, leading to pericarditis and pericardial effusion (fluid accumulation around the heart). In some cases, the aorta (main artery) may also become inflamed, a condition known as aortitis.

I would suggest the following investigations:

Electrocardiogram (ECG).
Echocardiography (ECHO).
Treadmill test (TMT).

In cases of acute chest pain, blood tests such as troponin I and high-sensitivity C-reactive protein (hsCRP) are useful.

Methotrexate is generally considered cardioprotective, although it may rarely cause drug-induced myocarditis (inflammation of the heart muscle). Adalimumab should be used with caution, as it may worsen or precipitate heart failure in some individuals.

Acetylsalicylic acid and statins (cholesterol-lowering medications) are often beneficial for cardiovascular protection. However, they should only be taken after medical advice to avoid potential interactions and side effects.

Steroids (corticosteroids) may be harmful to the heart when used long-term, as they can increase heart muscle mass, raise blood pressure, and accelerate atherosclerosis (plaque buildup in arteries). They may also increase the risk of atrial fibrillation (irregular heart rhythm).

Regular exercise is generally beneficial, but it should be planned under the guidance of both a rheumatologist and a cardiologist to ensure safety for joints and the heart.

Rheumatoid arthritis is associated with an increased risk of cardiovascular disease and stroke, estimated to be around 60 percent higher than in the general population. Proper control of inflammation, regular monitoring, and a multidisciplinary approach are essential for reducing this risk.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.