Rheumatoid Arthritis Cure
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What are the risks of heart disease in rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic, progressive, systemic, autoimmune disease for which there is no current treatment. It is a common disorder that affects more than 2.1 million Americans.
Patients who complications of RA outside the joints, which is called extra-articular disease are particularly at risk of early death. problems Extra-articular can be seen in RA include skin ulcers, anemia, eye inflammation, lung inflammation and damage, heart disease, inflammation of blood vessels, and rheumatoid nodules (bumps are composed of scar tissue that grow in certain areas such as fingers, elbows, heels, and the back of the skull).
A predictor of the presence of extra-articular disease is the level rheumatoid factor in blood. More rheumatoid factor, most patients will extraarticular disease.
A newer blood markers, anti-CCP (Cyclic citrullinated peptide anti), also appears to predict a higher risk of extra-articular problems as well as more serious illnesses.
The bottom line is that RA is not a benign condition. In fact, it carries the same mortality as early heart attacks, untreated diabetes, and Hodgkin's disease stage 4 in some studies. RA should be diagnosed and treated aggressively.
Probably the primary cause of the increase of cardiovascular mortality is death. The estimates vary between 33-50% of all deaths in RA are due to cardiovascular causes. Patients RA are significantly increased risk of atherosclerosis, congestive heart failure heart attack, and vasculitis (inflammation blood vessels).
If What are some risk factors that are particularly important?
Among these are:
• Severe RA disease
• severe extra-articular disease
• The high blood levels of homocysteine which is aggravated by methotrexate
• Abnormalities of blood vessel walls
• Drugs that are used to treat rheumatoid arthritis such as corticosteroids and non-steroidal anti-inflammatory
• The overproduction of inflammatory cytokines (chemical messengers disease)
• rheumatoid nodules
A note on drugs …
Methotrexate, the most commonly used drugs disease-modifying anti-rheumatic is associated with a significant reduction in the incidence of cardiovascular death. Unfiortuantely, nonsteoridal anti-inflammatory drugs that are commonly used to treat the symptoms of RA increase the risk of blood clots, cardiovascular disease and congestive heart failure.
The role of other medical problems such as blood glucose, lipid levels, and so on are a matter for another article.
Recommendations for reducing cardiovascular risk in patients with RA include:
• aspirin low dose (which should be completed by a certain type of stomach protection), especially in patients taking non-steroidal anti-inflammatory.
• Statins for people with high lipid
• folic acid supplementation to minimize levels elevated homocysteine seen in rheumatoid arthritis
• Attention to the use of TNF inhibitors in patients congestive heart
• Control of co-morbid conditions, such as smoking, diabetes, hypertension and who could exacerbate the tendency to cardiovascular risk.
Complicating this issue is data showing that TNF inhibitors can elevate serum lipids, in some cases. The implications of this phenomenon on the overall picture is still unknown.
A bright note: there is increasing evidence that aggressive treatment with methotrexate and TNF-inhibitors reduced the incidence of cardiovascular events. Therefore, the problem of fat above can not be that important. Further studies are obviously needed to confirm these results.
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info:
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