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Rheumatoid (Arthritis) Heart Disease

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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.

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Kelly Young. All rights reserved.

This entry was posted on Wednesday, April 27th, 2011 at 6:00 am and is filed under RA Education. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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