A new study confirms the strong link between rheumatoid arthritis and life-endangering congestive heart failure.
The 165 Minnesota residents in the study with rheumatoid arthritis were twice as likely to develop heart failure over a 15-year period than 116 residents of similar age and gender who did not have the autoimmune disease.
The findings by Mayo Clinic researchers appear in the February issue of Arthritis and Rheumatism.
Other studies have demonstrated the same link, said study author Dr. Paulo Nicola, a Mayo research fellow. “This one followed patients from the beginning of the disease, describing how the increase in heart-failure risk was present in the early stages and throughout.”
Rheumatoid arthritis is a disease in which the body mistakenly attacks its own tissues, causing painful inflammation and loss of joint function. While the study was not designed to address the reason for an increase in heart failure - a condition in which the heart progressively loses its ability to pump blood - “several studies in the general population suggest that inflammation may be a direct cause of heart failure,” Nicola said.
The study did show the need for aggressive treatment of risk factors for heart disease and stroke, such as high blood pressure and diabetes, in people with rheumatoid arthritis, he said.
“The clinician should be aware of the higher risk of heart failure and look for the early symptoms of heart failure even in people without cardiovascular risk factors,” Nicola said. “Treatment should be focused not only on the rheumatoid condition, but also on control of those risk factors.”
The severity of arthritis in individual patients must also be taken into account, said Dr. William S. Wilke, a rheumatologist at the Cleveland Clinic.
“A more active rheumatoid disease is a sign of greater risk of heart disease,” he said. “If we treat people aggressively with medications such as Methotrexate and tumor necrosis factor, we can significantly reduce the risk of heart disease.”
While rheumatoid arthritis always requires constant treatment, “this problem has a lot to do with how active the disease is,” Wilke said. “If we don’t control arthritis aggressively from the start, it’s going to eventually show not only a bad outcome of the disease but also bad outcomes all over the place.”
The report “highlights rheumatoid arthritis as a potentially life-threatening condition,” said Dr. John H. Klippel, president and CEO of the Arthritis Foundation.
“We’ve certainly become aware of cardiovascular disease as a risk factor for premature death in rheumatoid arthritis,” Klippel said. “People with rheumatoid arthritis have a life expectancy of roughly a decade less than those without the disease. At least one study has suggested that if one can get inflammation under control, there is increased survival.”
The inflammation that attacks the joints in rheumatoid arthritis is believed to foster the process in which fatty plaques in the walls of arteries burst, releasing clots that can block the blood vessels.
Revision date: June 18, 2011
Last revised: by Jorge P. Ribeiro, MD