Rheumatoid (Arthritis) Heart Disease | Rheumatoid Arthritis Warrior

Rheumatoid (Arthritis) Heart Disease

Most webpages about Rheumatoid Arthritis (RA) will tell you that you can reduce your risk for heart disease by eating healthy and reducing lipid levels. That’s seems instinctive for people to believe. However, evidence does not support it.

Do lipids matter with Rheumatoid heart disease?

plate of baconThe famous Red Dress Campaign for heart disease awareness in women lists Rheumatoid Arthritis as a risk for heart disease. Of course women should eliminate every risk they have for heart disease, like my friend Julie who sent me that link and worked hard to get her lipid levels down! The question is this: Can we reduce the risk of Rheumatoid heart disease? Do lipids matter?

I was fascinated by research published at the last ACR meeting showing There Are No Differences in Lipids between RA Patients and Their Siblings, Despite Higher Incidence of CHD in RA. Examining causes for heart disease in RA is critical because “the increased risk is still unclear with contradictory data regarding the role of lipids and their response to treatment.” Investigators who studied siblings concluded: “RA patients have higher CHD (Coronary heart disease) than same sex siblings when matched for age, sex, diabetes and smoking status. They have lower BMIs and higher inflammatory markers. This data suggest that lipids within this RA population were not a major component of risk.”

Why is “Rheumatoid heart disease” so different from other heart disease?

Rheumatoid heart disease is a phrase that I thought of last year as I realized that I didn’t want to say heart disease and RA; I wanted to say the heart disease of RA. Hopefully this phrase will catch on as a few others have.

I shouldn’t have been so surprised today when I found some very old articles using the phrase Rheumatoid heart disease. The New England Journal of Medicine in 1962 discussed Rheumatoid Heart Disease — A Study of the Incidence and Nature of Cardiac Lesions in Rheumatoid Arthritis: “Cardiac lesions are known to occur in rheumatoid arthritis but have seldom been recognized before autopsy. The relation between rheumatoid arthritis and heart disease may not have been readily apparent for various reasons.”

And Harris in 1970 wrote a case study Rheumatoid heart disease with complete heart block, which was quoted by at least 16 articles during the 80’s and 90’s. Three months prior to the woman’s heart failure, “no abnormality of her heart was found” upon “clinical examination.” A photo and details are given of her heart. “Only the basal third of the right coronary cusp was present and was strikingly thickened; the remainder of the cusp had been destroyed…” Many more details are given about the condition of the woman’s heart including findings of “fibroblasts” and “histiocytes” and “several rheumatoid granulomata.” Harris concludes: “Clinical studies show that rheumatoid disease of the heart may present in a variety of ways, including heart block.”

What does the evidence say about Rheumatoid heart disease and what do we need to know? Let’s look at a list of specific facts: 20 Facts About Rheumatoid Heart Disease.

We know that Rheumatoid heart disease is a part of RA that various researchers have documented for several decades. We know that we cannot expect it to behave the same way as other heart disease when it comes to diagnosis or treatment.

Note well: Rheumatoid heart disease is not a complication of RA. It IS part of the RA. We should stop using the word complications to describe various aspects of the actual disease for several reasons.

Recommended reading

Edit: 1/14/12 added link to related post.

Kelly O'Neill Young

Kelly O'Neill (formerly Kelly Young) has worked over 10 years as an advocate helping patients to be better informed and have a greater voice in their healthcare. She is the author of the best-selling book Rheumatoid Arthritis Unmasked: 10 Dangers of Rheumatoid Disease. Kelly received national acknowledgement with the 2011 WebMD Health Hero award. She is the president of the Rheumatoid Patient Foundation. Through her writing and speaking, she builds a more accurate awareness of rheumatoid disease (RD) aka rheumatoid arthritis (RA) geared toward the public and medical community; creates ways to empower patients to advocate for improved diagnosis and treatment; and brings recognition and visibility to the RA patient journey. In addition to RA Warrior, she writes periodically for newsletters, magazines, and websites. There are over 60,000 connections of her highly interactive Facebook page. You can also connect with Kelly by on Twitter or YouTube, or LinkedIn. She created the hashtag: #rheum. Kelly is a mother of five, longtime home-schooler, NASA enthusiast, and NFL fan. She has lived over thirteen years with unrelenting RD. See also https:/rawarrior.com/kelly-young-press/

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20 thoughts on “Rheumatoid (Arthritis) Heart Disease

  • April 27, 2011 at 9:02 am
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    Very interesting. Thanks for the info! 🙂

    But I suppose having Rheumatoid heart disease isn’t going to prevent me from compounding it with regular old heart disease, seeing as I seem to have emerged from the murky end of the gene pool and all. Guess I won’t push my luck on the lipids…. 🙂

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  • April 27, 2011 at 11:30 am
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    With the medication I am taking which is Actemra I have to have fasting lipid panels every month. My tryglicerides and LDL’s have flucuated dramatically since taking this biologic. My last one taken in the latter part of April has my tryglicerides and LDL’s extremely high. I have never had a problem with my cholesterol before, actually is was in the very good range. Now I am worried I may have to take a statin to keep the numbers in range, statins haven’t worked well in my family–due to the muscle pain in the legs (which statins will cause). I have tried OTC Niacin, maybe I should increase the dosage slightly.
    I am wondering if a round of Prednisone would have anything to do with the cholesterol levels. Does anyone know?

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    • April 27, 2011 at 12:31 pm
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      Sheila,
      Actemra does affect lipids in some patients – that’s why their keeping a close eye on it – I’m pretty sure your doc would pull you off the Actemra before having you go on another drug to control cholestorol – but that is only a guess based on what I’ve been told. Have you asked the doc where he’d draw the line?

      Reply
  • April 27, 2011 at 2:40 pm
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    The low-back pain is an ailment that causes many expenses to the companies because this disease is one of the most common cause of work absenteeism. It is why the low-back pain is recognized in the world like a problem of world-wide health.

    Many factors exist that can aggravate the lumbar complaints such as overweight that causes our it support to endure greater weight of things, the stress that it causes when the muscles are put keep, bad position when sitting, the sedentary life and the lack of calcium; not allowing to fortify the bones.

    Mentions Findrxonline as the acute low-back pain is mainly an appearance after some effort that causes muscle stretch, this low-back pain is of short duration and it is possible to be fought with analgesics like Aspirin, Acetaminophen, Ibuprofen, Naproxen, VicodinLortab Lorcet Norco, Percocet, Percodan, MSIR, Oxycontin, Dilaudid and other pain killers.

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  • April 27, 2011 at 3:06 pm
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    A confusing topic to say the least. A lot of things have to be teased out. One has to take into account also how each of the different current RA treatments also affect lipid levels and how this affects RA heart disease. One big point to remember is that it is often more silent in RA than regular folks.

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  • April 27, 2011 at 4:02 pm
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    Before my cholesterol went up and he wasn’t pleased, but like I told him I don’t really eat “a lot” of junk food. Don’t eat fatty foods. This time he didn’t see the results of the blood work cause I had to see them and the nurse said she hadn’t recieved them. Before this they have leveled out pretty good. This time and I have no idea why they spiked pretty high, both tryglicerides and LDL’s!!! Not good. He told me before I have to watch them closely, but my goodness I could see if I was eating junk a lot. Before the Actemra, never had a problem with cholesterol. So I am not sure what he is going to say. Usually when I am getting infusion I don’t really see him. Just the nurse. I am sure he will want to see me now after these levels.

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    • April 27, 2011 at 8:23 pm
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      yes, he probably will. and maybe you can ask him *why* the cholesterol goes up. I was told while I was on it that it’s not just the cholesterol levels themselves, but that it’s a sign that something else is being affected by the drug – I need to look that up because I can’t remember what that is.

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  • April 27, 2011 at 4:15 pm
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    Sheila – I’m taking Actemra and now have high cholesterol levels (I didn’t before). Apparently it’s a common side effect. Here in the UK, they treat with statins rather than stopping the Actemra. I’m relieved, as right now I’d rather have the cholesterol problem than my RA symptoms back. The Actemra has just about wiped out the RA, and according to my rheumy, that means it’s also preventing other stuff like Rheumatoid Heart Disease. I haven’t started the statins yet, so I don’t know how I’ll get on with them. Seems like we swap one set of problems for another! But I’m definitely sticking with the Actemra for as long as they’ll let me.

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    • April 27, 2011 at 8:13 pm
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      Does your rheum doc actually use that phrase “Rheumatoid heart disease”? I’ve haven’t heard a doctor use it or seen it in current literature & I’d be glad to know that the term is spreading! Unfortunately there is no known way to prevent it, but aggressively treating the RA is our best bet, so I hope that works as he said.

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      • April 28, 2011 at 4:16 am
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        I think the expression may be mine, rather than my doctor’s. In the UK, the Drs would probably avoid ‘Rheumatoid Heart Disease’, as it sounds too much like ‘Rheumatic Heart Disease’ which is a very different condition (I’m told). But my Rheumy runs a research unit and is *passionate* about improving the lives of RA sufferers. His team have been very informative, about all the problems associated with RA, and the side effects of the treatments. Everything is discussed with me in a balanced way. I am lucky, as I was part of the research trials for Actemra in the UK, so have access to these wonderful people. I have a friend who is has RA worse than me, is treated at the same hospital, by a different doctor. He doesn’t get the same level of care and information. I thought the the variations in the quality of care were due to our NHS system, but it seems like it’s the same for you people in the States!

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  • April 27, 2011 at 9:16 pm
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    Until all of the rheum docs work **together with cardiologists, orthopedic surgeons and primary care docs, I do not have great confidence in the care we RAers are getting. As good as my rheum is, he hasn’t mentioned going to a cardiologist. I will take this up with him next visit. Same with my internist. My husband, with “typical” genetically inherited horrible heart disease, has a great cardiologist (for him), so I’ll get a referral there. We’ll see what he has to say. SIGH! another doc, another co-pay. Another procedure, another co-pay. At last calculation, over 3/4 of our income goes to medical insurance, Rx’s, & doc visits. I’m wondering if we will have to take out a loan for food next winter. Trying to balance one thing against another is interesting to say the least.

    But it’s discouraging to realize that all this expenditure is really just a delaying action. In the end, our hearts probably will get us, despite all the Rxs and treatments.

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    • April 29, 2011 at 6:26 am
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      I had to smile on that piece meal doc approach you mentioned. I feel the best way to reduce healthcare costs in this country is to do an approach I had when I first got diagnosed with ra. All my docs were housed in one complex including the labs, xrays, etc. Every doc shared the same set of records and there was only one set in a main file room that was pulled and sent to your docs appointment. This approach reduced so many redundent tests, etc. It drives me crazy keeping track of which doc ran what tests and trying to make sure that another doc doesn’t order a repeat test of something I recently had done already. And then talk about the right hand not knowing what the left hand is doing with meds…ugh!! And they all expect you, the patient to listen to them first. Reminds me of the headless rider soaring down the path. I feel like a puzzle spread out on a table. Each piece a seperate specialty with nar a soul to put me back together again 🙂

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    • July 21, 2011 at 3:20 pm
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      Boy did you hit the nail on the head – none of the Dr..communicate- and I feel I have a great rheum.Dr. and she does push for check ups but if I see another Dr they never send info back to rheum Dr- I had cardio.Dr do a CT on the heart called ” calcium score” and I have plaque buildup already -but while doing the CT had them do a chest shot and found noduil on lung. We all need a note book to take to each Dr apt to make sure they are following up on potential problems because the Dr. are not.

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      • July 21, 2011 at 4:10 pm
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        making your records electronic would help solve this – as long as you were allowed to correct errors & have control over who sees them. It is coming eventually, hopefully with proper safeguards. I’m glad your cardio doc knows what to look at – good luck w/it.

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  • April 29, 2011 at 11:14 am
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    My name is Rita Thomas, and I am a Medical Research Coordinator for a market research firm in Chicago, called Fieldwork (www.fieldwork.com). We currently have a study going on about Rheumatoid Arthritis, and are looking for a specific type of patient. We are looking for sufferers who USED to take a TNF-Inhibitor like Enbrel, Humira, Remicade, Simponi or Cimzia and has recently switched to Rituxan, Kineret, Orencia or Actemra/RoActemra. We are also looking for sufferers who have recently switched from one TNF-Inhibitor to another TNF-Inhibitor (Enbrel, Humira, Remicade, Simponi, Cimzia). I thought by posting here, some of you would enjoy the chance to help in this important research. The study is on-line, lasts approximatley 45 mins and we’ll compensate you $75 for your time and opinions. I’d like to assure you now, we do not engage in sales, and your interview is completely confidential. If you’d like to speak with me to learn more about the study, or to answer the qualifying questions, give me a call at 888-863-4353 and ask for Rita Thomas.
    Thanks for your help in this important research.
    Sincerely, Rita Thomas
    Medical Research Coordinater

    Reply
  • January 15, 2012 at 2:55 pm
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    This is a very timely message as we have 3 or 4 people in our community going through various forms of Rheumatoid Heart disease right now. I’m sure the meds we take do not help matters at all with our hearts, but the poison that keeps me walking is the poison I choose. Thanks Kelly good article.

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  • January 15, 2012 at 3:28 pm
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    Probably about 10 years ago my Rheumo stressed to me the importance of seeing a Pulmonary Specialist twice a year. I believe it’s a must for anyone with RA!!!!

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  • January 15, 2012 at 3:57 pm
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    Very interesting! I have a pre-existing heart condition and when I asked my cardiologist about additional heart issues after being diagnosed with RA, he told me there were none. Looks like I’ll be cardiologist shopping. *sigh*

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  • January 15, 2012 at 5:02 pm
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    My rheumatoid heart disease presented as high pulse rate, intermittently elevated blood pressure and shortness of breath on minimal exertion. All my cardiac labs, echocardiogram, stress test and EKG were normal. My cardiologist told me that the thickening in the heart can be similar to a rheumatoid nodule.They think my abnormality is near my natural pacemaker.
    I have spent the last year getting everything else ruled out, but it looks like sometime this spring I will be having an ablation and pacemaker insertion. I will still have to be on cardiac meds after, but hopefully I can get up and go again.

    Reply
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