Rheumatoid Arthritis and Matters of the Heart

Getting a handle on RA can help you manage heart disease. Take a cue from one runner on how to keep your ticker in tip-top shape.

Health Monitor Staff
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Brian Murphy, 60, had always been an avid runner who also enjoyed playing volleyball and zooming around on a snowmobile. His blood pressure was normal, he had no family history of heart disease and he was careful to eat a healthful diet. In fact, the computer specialist from Kinderhook, NY, thought he was pretty healthy for a guy his age. Until last year, his only health problem was rheumatoid arthritis (RA), which had been in remission for nearly 20 years.

But, in late 2009, a routine blood test showed that Brian’s cholesterol levels were elevated. A few months later, he was hit with chest pain during one of his regular runs. The chest pain returned the next day when he was exercising on an elliptical machine. “I knew it wasn’t just gas,” he says.

Brian underwent an electrocardiogram (EKG), a test that measures the electrical activity of the heart, which didn’t reveal any problems. Next, he was given a stress test, which measures how well your heart functions when stressed by exercise. Immediately afterward, Brian was sent directly to the hospital, where doctors did an angiogram. “They saw that I had two blocked blood vessels,” he recalls. “One was 60% blocked; the other was 90% blocked.”

The next morning, surgeons performed double coronary bypass surgery. Although Brian didn’t know it at the time, having RA was probably a major contributor to the development of his coronary artery disease. “I thought I was fine,” he says. “It was a total shock.”

The inflammation connection
Brian is not alone. Most people with RA are all too familiar with pain, low-grade fever and fatigue. Until recently, many people were unaware that having RA increases their risk of developing heart disease and dying of a heart attack. Studies also have shown that people with RA are prone to developing stiffness in the ventricles (chambers) inside the heart. This can lead to heart failure, a condition in which the heart muscle weakens and cannot pump blood efficiently.

“RA patients have the same risk for heart disease as patients with diabetes,” says Eric Ruderman, MD, a rheumatologist and associate professor of medicine at Northwestern University. “About half the increase in risk is related to factors such as smoking, unhealthy cholesterol levels and excess weight. But the rest of the increase in risk comes from the RA itself, specifically the inflammation.”

The RA-related inflammation that wreaks havoc on joints also affects arteries, since it contributes to a thickening of the blood vessels, says Scott Zashin, MD, clinical associate professor of medicine at the University of Texas. Dr. Zashin adds that the pain and stress of having RA may also limit a person’s mobility. That can cause unhealthy weight gain, which is yet another risk factor for heart disease. For patients with RA, part of the key to reducing heart disease risk is to get the RA under control.

Doctors use a number of medications to manage RA. Some of the most advanced are a class of medications known as biologics. Biologics are designed to prevent or reduce the inflammation that damages joints.

On the lookout
In addition to taking prescribed medication to reduce inflammation, people with RA should be vigilant about managing other heart disease risk factors, says Kimberly Liang, MD, a rheumatologist and researcher at the University of Pittsburgh. Among other things, Dr. Liang urges patients to exercise to the best of their ability. “I often recommend swimming-pool exercises as a good way to get aerobic activity,” she says. “It places less load on the joints.”

After his bypass surgery, Brian switched from running to walking—temporarily. “My heart function is better than it was prior to surgery, and if my knees feel strong and pain-free over the next month, I will start to jog again!”

October 2012