Thursday, January 1, 2009

Rheumatoid Arthritis a risk factor for Heart Attack and Stroke

My Aunt died suddenly few years ago due to a massive Heart Attack[Myocardial Infarction]. She was suffering from Rheumatoid Arthritis[RA] for a long time.Her Arthritis was fairly under control and was active in life when she was suddenly taken away by death. Her sudden death was a shock to me.It made me research the literature to find out any connection between Rheumatoid Arthritis and Heart Attack.The findings were very revealing.
Several studies have found out that those who are suffering from RA has double the risk for Cardiovascular disease [which includes heart attack and stroke] than General Population.The risk is almost same as those who have Type2 Diabetes.
As more more and more such studies were published an expert committee was appointed by European League against Rheumatism[EULAR], the professional body of Rheumatologists in Europe.Now the Task Force has come out with its recommendations which can be read here. This was published at EULAR 2008 the Annual Congress of the European League Against Rheumatism in Paris, France in June 2008.

The EULAR Task Force’s multidisciplinary steering committee comprised 21 members, including rheumatologists, cardiologists, internists and epidemiologists, from across nine European countries.
This recommendations are applicable not only to RA patients but also to Ankylosing Spondylitis[AS] and Psoriatic Arthritis[PsA] patients.
What does this recommendations mean for RA,AS,PsA patients?
Persons suffering from RA,AS orPsA have very high risk of getting a Heart Attack or Stroke when compared to those who do not have RA,AS or PsA.
Any one having the above rheumatological diseases should undergo active screening for other Cardiovascular risk factors like Diabetes,High Blood Pressure,High Cholestrol etc.If any such risk factors are present they should be actively managed by lifestyle modification including diet and exercise,medicines and frequent monitoring. They should refrain from using tobacco.They should also undergo frequent screening for Coronary Artery disease by Electrocardiography[ECG/EKG],Exercise Stress Test[Treadmill Test] and or Angiography which ever is applicable in a particular patient.
Though the task force have not specified a target value,it can be inferred that the target values for Blood Pressure, HDL and LDL Cholesterol should be similar to the target for Type 2 Diabetes patients.
So RA patients should keep their
Blood Pressure below 130/80
LDL Cholesterol below 100mg/dL
HDL Cholesterol above 40mg/dL

It is hoped that the Task Force recommendations will directly contribute to improved clinical practice and better the life of Rheumatoid Arthritis patients.
I wish such recommendations were there 5 years ago.If so my Aunt might have been still alive.

8 comments:

Santhanam said...

This was a real eye opener. Thanks because this takes the field of rheumatology into an altogether different level. In a country like India, many with joint pain go for alternative medicine , some even go to quacks who offer steroids mixed with some pain killers. the actual differential diagnosis doesnt seem to bother even many of the general practitioners of Allopathy who prescribe some painkillers and placebos for symptomatic relief. This revelation makes it all the more important that we practitioners of allopathy medicine investigate the patient thoroughly and classify them accordingly . this will help identify those who can benefit from lifestyle modification.
Thanks for this important bit of information. I will make sure I spread this as far and wide as I can.

Tharun said...

good post Sir. I reached this post accidentally. I am an MBBS student doing my 4th year and my maternal aunt has recently been diagnosed with RA.Even though I feel shaky after reading this post, I think at least my aunt has a better chance in life now that the connection between cardiac risk and RA is known.I feel humbled by the enormous amount of information that seems to be bombarding us daily regarding science and technology. Thanks once again for the post.

Charakan said...

Thank you Santhanam. I have noticed this relationship for few years now and thought it might be due to increased NSAID use and Diabetes that many RA patients develop [due to systemic steroids].Now the studies have proved that independent of use of NSAIDS and co existing Diabetes there is almost double risk for CV events in RA patients.

Charakan said...

Tharun, Welcome to this blog. Thank you for the comment. Yes tons of information are coming out daily in Medical field.Some are very important and help your patient directly and immediately like the one about RA and CV risk. Many other information may not be that relevant in clinical practise but may help in future Research.
Rheumatology is a promising Subject that you can choose for specialisation in future.

BrokenHeart said...

So sorry about your aunt. I too lost an aunt who was close to me recently from heart disease.

As for the arthritis, I have a double whammy, both type 2 diabetes and rheumatoid arthritis. I had a severe RA attack when I was in my 20s. Supposedly, it went into remission, but the pain never fully stopped. And now that I'm getting close to menopause, the disease is suddenly back with a vengeance, and I'm in constant pain and overnight I've developed Hallus Ridigus. I believe it's caused, 100% from hormones, specifically estrogen decline, which is why I think women outnumber men 3 times to 1 in getting this disorder. I've always noticed that it gets significantly worse during the PMS phase when estrogen is lowest.

The increased risk for heart disease is scary.
I'm going to try and get on HRT ASAP and see if I can shut this thing off.

Thanks for publishing this article. :-)

mike said...

People with Rheumatoid Arthritis have their immune system turn on itself. Doctors do not understand why but the healthy parts of the body come under attack by it's own defence system. The faulty immune system targets the joints of the body and starts off at the hands and feet. As it progresses it slowly destroys the cartilage at these joints. These joints are made up of several parts. The cartilage allows the bones to move against each other which allows the joints to move. There are also ligaments which hold the bones in place. Over time people with this disease can get stiffness and loss of mobility.
Please visit the following sections for more information:
Ankylosing Spondylitis Symptoms
Treatment Of Ankylosing Spondylitis

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apu said...

Dear Doc,
I came to this post somehow, and it so resonated with me. My mother has been suffering from RA for the last 10 years, and it seems as if doctors themselves know so little about it. I understand there is no cure yet available, and as of now they can only help control pain and inflammation. Yet, even empathy for the patient and listening to her unique case is missing. There is a tendency to just tell the patient to grin and bear it. I am worried about the risk of heart attack, although her BP is fairly stable (under medication). I'm not sure what you could do to help, but if you know of any patient groups/ support groups in India and esp in Chennai, please do let me know.