3 Topics in the News on Rheumatoid Arthritis Heart Disease

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Rheumatoid “Arthritis” in the heart – no joints, but plenty of problems

Often, I have sharp chest pains, but I know it’s not my heart – click here if you don’t know what it is. (Hint: there are joints along the sternum.) But when a large butterfly flutters in my chest and tries to escape through my neck, I know that IS my heart. For a while I’ve also had shortness of breath upon exertion (with exertion being taking a shower).

Somehow with my mostly normal-looking hands, I thought I might escape other types of Rheumatoid damage. I know better, so maybe it’s wishful thinking. Or maybe it’s the docs who’ve told me I didn’t look sick, and paid no attention to my fevers, permanently swollen knees, bent toes, and deteriorating spine. For whatever reason, I’m facing reality that I’m not exempt from the high risk of atrial fibrillation in RD. So, as I make my appointment for a heart ultrasound today, let’s look at 3 things from my long list of Rheumatoid / heart news items.

lincoln-quote-reality-heart

1) Rheumatoid disease changes the left ventricle of the heart

Researchers at Mayo Clinic found that Rheumatoid disease is strongly associated with abnormal concentric remodeling of the left ventricle of the heart.[1] The investigators determined that “RA disease–related factors may promote changes” in the geometry of the left ventricle of the heart. The association was not attributable to traditional cardiovascular risk factors and comorbidities. (In other words, they necessarily can’t blame your weight, smoking history, or the fact you’re not a vegan. It’s the RD.)

By the way, Myasoedova et al. are not the first to recognize a problem with the left ventricle in Rheumatoid Disease. Bhatia et al. raised an interesting question in 2006: Left Ventricular Systolic Dysfunction in Rheumatoid Disease: An Unrecognized Burden? Seven years later, it is still largely unrecognized, but I’m glad to report that a handful of doctors are investigating it.

2) They’re debating whether evidence warrants cardiovascular risk management in PRD

This summer, a debate continued about whether “evidence supports” the management of cardiovascular (CV) risk in people with Rheumatoid Disease (PRD).[2] This argument takes place at the intersection of science and management of resources. The question isn’t whether PRD have increased CV risk, but how much or what to do about that. In 2010, the European League against Rheumatism (EULAR) had published 10 recommendations for cardiovascular risk management in PRD.[3]

One thing stands out as this debate continues, few have recognized the reality of recommendation number one: “RA should be regarded as a condition associated with higher risk for CV disease.”[3] Reading up on atrial fibrillation today as I made my ultrasound appointment, one medical site after another gave a list of those at increased risk for “a Fib,” stroke, or other CV disease. You guessed it: none of them listed RD as a risk factor.

An article by Nathan Wei appearing on several sites states: “The notion that RA is a potentially crippling disorder is widely accepted. However what is not generally known is that it is a potentially lethal disease leading to an increased risk of heart attack and stroke.” He discusses a report that heart attack risk is lessened with TNF inhibitor (Biologic) treatment.

3) Higher prevalence of diastolic dysfunction in Rheumatoid Disease

screenshot from Aslam - CV risks in RDAslam et al. conducted a literature review of 25 studies of PRD to determine whether diastolic dysfunction and other cardiac parameters were different with RD.[4] They found “Patients with RA were more likely to have echocardiographic parameters of diastolic dysfunction, and have higher systolic pulmonary artery pressures and larger left atrial sizes.” The screenshot shows part of Table 3 of an analysis of outcomes.

HAVE A HEART

So what? Every few months we come back to this topic of Rheumatoid heart disease for two main reasons:

1) There’s a lot to be learned.

2) It’s the systemic effects of RD that make us feel unwell and shorten our lifespans, not twisted fingers.

This post does not begin to cover the ways that Rheumatoid Disease affects the heart. It would take a whole book to do that topic justice. There is a section on the heart in my first book, and meanwhile there are 18 posts on this site on the effect of RD on the heart – click here to read. Our mission is to get the best care we can for ourselves and the patients we care for, AND to help the medical world understand the ways RD affects patients.

MORE: Want to know more or know a doc who doubts the CV effects of RD? I recommend this short article written by a doc who leads the Preventive Cardio-Rheuma Clinic at Diakonhjemmet Hospital in Norway: RA and Carotid Plaques: Five Things to Know.[5] It reads much like a blog on this site with a list of quick facts and footnotes.

Recommended reading

FOOTNOTES

1 Myasoedova E, Davis JM, Crowson CS, Roger VL,. Karon BL, Borgeson DD,. Therneau TM, Matteson EL, Rodeheffer RJ, Gabriel SE. Brief Report: Rheumatoid arthritis is associated with left ventricular concentric remodeling: Results of a population-based cross-sectional study. Arthritis Rheum [Internet]. 2013 Jul [cited 2013 Oct 2];65(7):1713–1718. Available from: http://onlinelibrary.wiley.com/doi/10.1002/art.37949/full
2 Solomon DH (Initiator), Peters MJL, Nurmohamed MT (In Support), Dixon W (In Opposition). Unresolved questions in rheumatology: motion for debate: The data support evidence-based management recommendations for cardiovascular disease in rheumatoid arthritis. Arthritis Rheum [Internet]. 2013 Jul [cited 2013 Oct 2]; 65(7):1675–1683. Available from: http://onlinelibrary.wiley.com/doi/10.1002/art.37975/full
3 Peters MJL, Symmons DPM, McCarey D, Dijkmans BAC, Nicola P, Kvien TK, McInnes IB, Haentzschel H, Gonzalez-Gay MA, Provan S, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis [Internet]. 2010 [cited 2013 Oct 2];69:325-331. Available from: http://ard.bmj.com/content/69/2/325.long
4 Aslam F, Bandeali SJ, Khan NA, Alam M. Diastolic dysfunction in rheumatoid arthritis: A meta-analysis and systematic review. Arthrit Care Res [Internet]. 2013 Apr [cited 2013 Oct 2];65(4):534–543. Available from: http://onlinelibrary.wiley.com/doi/10.1002/acr.21861/full
5 Semb AG. RA and carotid plaques: Five things to know. Rheumatology Network [Internet]. 2013 Feb 7 [cited 2013 Oct 2]. Available from: http://www.musculoskeletalnetwork.com/rheumatoid-arthritis/content/article/1145622/2127227

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Kelly Young. All rights reserved.

This entry was posted on Wednesday, October 2nd, 2013 at 4:44 am and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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