Rheumatoid Arthritis and Heart Disease: The Hidden Connection

Rheumatoid Arthritis (RA) is mostly associated with a condition of the joints. Did you know that it can affect your heart health as well? Yes, RA can very well affect the heart and lead to various cardiovascular issues. If you are wondering how the two are connected to each other, this article will answer it for you in depth. 

To get a complete picture of this, the editorial team of OnlyMyHealth reached out to Dr Chethana D, Senior Consultant – Rheumatology, Aster CMI Hospital, Bangalore, and Dr VP Sharma, Director and Senior Consultant Cardiology, Fortis Hospital Jalandhar.

Does Rheumatoid Arthritis Affect The Heart?

Let us understand what RA is. Dr Chethana explains, “RA is an autoimmune condition where the body’s immune system attacks its own joints, but the inflammation can also affect other parts of the body, including the heart and blood vessels.”

Let us understand whether RA can actually affect the heart or not. “Yes, Rheumatoid Arthritis can affect the heart. People with RA have a higher risk of developing heart diseases. People with RA are also more likely to develop conditions like high blood pressure and abnormal cholesterol levels, which further increase heart risk. In some cases, RA can directly affect the heart tissues and cause problems such as inflammation of the heart lining (pericarditis), heart muscle (myocarditis), or heart valves. Another reason for increased risk is that people with RA may be less physically active due to joint pain, which can affect overall heart health. Some medicines that are used to treat RA may also have side effects that impact the heart, although many modern treatments help reduce inflammation and lower heart risk,” explains Dr Chethana.

As per a 2024 study, published in the Cureus journal, chronic inflammatory state in RA is indeed a risk factor for the progress of cardiovascular disease. The review further highlights that the early diagnosis of RA and evaluation of inflammatory markers such as anti-citrullinated peptides, ESR, and CRP are important, and early treatment with anti-inflammatory drugs in RA patients can minimise the development of complications like heart failure (HF). 

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How Rheumatoid Arthritis Progresses into Heart Diseases

A 2011 study, published in the Arthritis Care and Research journal, highlighted how RA can progress into heart diseases, and what are the factors leading up to it. It noted that RA is more than just a condition of the joints. It can affect the entire body. RA causes constant and chronic inflammation. These inflammatory molecules attack the delicate inner lining of the blood vessels, causing them to damage and become stiff. This can accelerate atherosclerosis, a process where fat, cholesterol, and other substances form sticky plaques inside the arteries. 

The findings further added that RA causes joint pain, leading to low activity or physical movement. This can cause physical stress, fatigue, weight gain, and high BP, further elevating risk of heart diseases. There are certain medications used to treat arthritis that can increase BP and strain an individual’s cardiovascular system. To summarise, the study concluded that RA can definitely progress into heart diseases by turning the body’s immune response against its own blood vessels. 

What Is the Link between RA and Heart Diseases?

Let us dive deeper into the connection between RA and heart diseases. “The main connection between RA and heart disease is long-term inflammation. In RA, inflammation does not stay only in the joints; it can spread through the bloodstream and damage blood vessels. This can lead to a condition called atherosclerosis, where fatty deposits build up inside the arteries. Over time, this can narrow the arteries and increase the risk of heart attack and stroke,” shares Dr Chethana.

Adding to this, Dr Sharma shares, “It is a known fact that people living with rheumatoid arthritis have a significantly higher risk of suffering from cardiovascular diseases, irrespective of whether they have risk factors or not. Inflammation itself becomes the driving force behind this added risk. Heart disease in RA patients can develop silently, further raising the concern. There is also a higher chance of heart failure and inflammation of the heart lining, along with blocked arteries.”

A 2023 study, published in the Health Sciences Review journal, noted that patients with Rheumatoid Arthritis (RA) have a 50% greater risk of getting diagnosed with cardiovascular diseases (CVD) and a 50–60% higher rate of cardiovascular-related mortality, as compared to the general population.

How Rheumatoid Arthritis Patients Can Protect Their Heart 

This 2015 study, published in the Autoimmunity Review journal, explains how heart conditions in RA patients are often silent and lack typical symptoms. The findings shared certain tips that can help RA patients protect their heart:

• RA patients should build a personalised prevention plan that targets both everyday heart risks and their specific autoimmune condition. The most important step is successfully controlling the underlying RA inflammation, ideally with the help of medications that are safe for the heart.
• Patients must keep their blood pressure, cholesterol, and blood sugar in control. Quitting smoking is important, as tobacco use worsens both RA flare-ups and build-up of plaque in arteries.
• Adopting a heart-healthy lifestyle, such as keeping weight in check and staying physically active, despite joint discomfort, is strongly advised.
• Patients must discuss the side effects of their medications with a doctor, as long-term use of certain painkillers or steroids may harm the blood vessels.
• Patients should consult their rheumatologists and ask for specialised cardiovascular assessments. 

The study summarises that a combined approach of preventing joint inflammation and managing lifestyle habits helps protect the heart of RA patients.

Which RA Patients Are At High Risk for Heart Diseases?

A 2022 study, published in Cureus journal, highlighted that those aged between 50 and 59 are said to be at higher risk for both the conditions. The findings added that these RA patients may be at risk for heart diseases:

• Those with severe and long-term arthritis are said to be at higher risk.
• RA patients who also have other underlying health conditions like diabetes, high blood pressure, or increased cholesterol levels. All these combined threats may lead to serious cardiovascular events like heart failure and strokes, that too much earlier in life.
• Those who are in their 50s and have aggressive RA, need proactive heart screenings like echocardiograms (ECG). 

How To Reduce Risk Of Heart Diseases Caused By RA

Prevention is always better than cure. Explaining how one can reduce risk of heart diseases caused by RA, Dr Chethana says, “To reduce the risk, it is important for people with RA to manage inflammation properly with the help of a doctor. Regular exercise, a healthy diet, not smoking, and controlling blood pressure and cholesterol are very important.”

According to a 2022 study, published in the Journal of Clinical Medicine, at present, screening (and treatment, if indicated) for cardiovascular (CV) risk factors is “still insufficient, resulting in undiagnosed and untreated risk factors.” The study noted that RA patients require “optimal control of their systemic inflammation and mandatory regular screening for CV risk factors to turn their CVD risk towards that of the general population”.

Lifestyle Changes To Reduce Heart Disease Risk For RA Patients

According to the Cleveland Clinic, these lifestyle modifications can reduce risk of heart diseases for RA patients:

• Get an annual cardiovascular risk assessment done.
• Increase your daily activity. Being physically active is crucial for managing RA. Start slow, but try to adopt an exercise routine that suits your fitness level.
• Follow a healthy diet. Opt for foods that are nutrient-dense, plant-based, and not processed.
• Avoid smoking.
• Manage stress, as it can worsen the inflammation and pain caused by RA. Following de-stress routines can help limit flare-ups.
• Get good sleep. 

Tests To Diagnose RA and Heart Diseases

Let us take a look at some tests that can help diagnose RA and heart diseases:

Rheumatoid Arthritis:

As per Centers for Disease Control and Prevention (CDC), doctors can diagnose RA with the help of:

• A physical exam.
• X-rays.
• Lab tests.
• A review of your health history

Heart Diseases:

According to the Mayo Clinic, these different tests are used to diagnose heart diseases:

• Blood tests
• Chest X-ray
• Electrocardiogram (ECG or EKG)
• Holter monitoring
• Echocardiogram
• Exercise tests or stress tests
• Cardiac catheterisation
• Heart CT scan, also called cardiac CT scan
• Heart magnetic resonance imaging (MRI) scan

When To See A Doctor?

If someone is struggling with rheumatoid arthritis, when is the right time for them to get checked for cardiovascular diseases? “In simple terms, RA doesn’t just stay in the joints but travels through the bloodstream and affects the heart over time. That’s why managing RA today goes beyond pain relief. Controlling inflammation early with the help of regular heart check-ups plays a crucial role in protecting long-term heart health,” says Dr Sharma.

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Conclusion

Rheumatoid arthritis is usually viewed as a condition that impacts the joints, but in fact, rheumatoid arthritis is a systemic inflammatory condition that involves the entire body, with the heart being one of the organs that it quietly affects. In simple terms, RA increases heart risk mainly because of ongoing inflammation, but with proper care and lifestyle changes, this risk can be managed effectively.