Association of Rheumatoid Arthritis with Coronary Artery Disease and Stroke Risk
We are well-known about the chronic rheumatoid arthritis (RA) disease, most commonly observed in middle to older aged people. This disease discomforts the human life leading to disability and painful living. Once people get rheumatoid arthritis, they have to take medication for life-long to relieve the pain and discomfort. Although advancement in medical treatment system and new drug discovery have improved the clinical treatment options and relieved the pain of the patients, severe rheumatoid arthritis can still cause physical disabilities (Arthritis foundation, 2021). More women than men are affected by rheumatoid arthritis.
What is rheumatoid arthritis?
Rheumatoid arthritis is the most common autoimmune and inflammatory disease with a prevalence of 1%-2% worldwide, which causes inflammation, joint pain, swelling and damage in the wrist and small joints of the hand, knee and feet. It can also impact the shoulders and knees. This disease can affect other parts of the body systems, including the skin, eyes, lungs, heart and blood vessels.
How does rheumatoid arthritis occur?
The disorder of the body’s autoimmune system mistakenly attacks human’s own body’s tissues, especially the lining of the joints, called the synovium resulting in rheumatoid arthritis (Arthritis foundation, 2021), which causes a painful swelling in the joints and eventually result in bone erosion and joint deformity. The autoimmune system fights their body’s cells as invaders, such as bacteria and viruses, and releases inflammatory chemicals that attack those cells. After inflammation, the synovium gets thicker making the joint area painful, tender, red and swollen. Therefore, it becomes difficult and painful to move the joint of hands, knee, ankle and shoulders (Arthritis foundation, 2021).
Symptoms
At early stage, people with rheumatoid arthritis may experience tenderness and pain in the joints indicating the clues for future rheumatoid arthritis. The severity of signs and symptoms of rheumatoid arthritis may vary from people to people and may last for short time or longer. Rheumatoid arthritis can cause severe problems like joints deformation. The common symptoms of rheumatoid arthritis are
- Joint pain, warmth, tenderness, swelling or stiffness.
- Joint stiffness that is usually worse in the mornings and after inactivity
- Fatigue, fever and loss of appetite
- More than one joint is affected.
People with rheumatoid arthritis can’t do exercise due to joint pain, leading to weight gain, which may cause the following diseases:
- High cholesterol,
- Diabetes,
- Heart disease and
- High blood pressure.
Other parts of body except joints
Rheumatoid arthritis may affect the other parts of body systems as below
Dry eyes and mouth, skin;
Disease in lungs, heart, kidneys, salivary glands, nerve tissue, bone marrow, blood vessels, and blood;
Osteoporosis (a condition that weakens your bones and makes them more prone to fracture);
Rheumatoid nodules (bumps of tissue in the elbows, heart, lungs, etc);
Lymphoma, Infections due to impaired immune system;
Carpal tunnel syndrome.
Risk factors contributing to rheumatoid arthritis
The following factors may increase the risk of rheumatoid arthritis: (a) sex (high prevalence in women than men), (b) age (more probable in middle age), (c) family history, (d) smoking, and (e) excess weight.
Treatment
Medical treatments can help minimize joint pain and swelling and prevent joint damage and deformities. Treatment at the early stage of disease can provide better results and protect the body from severe damage like deformation and joint replacement. Therefore, patients with rheumatoid arthritis should get correct diagnosis and consult with a rheumatologist, who can provide a correct treatment plan and treat arthritis and autoimmune disease. Treatment can stop inflammation, reduce pain, relieve symptoms, prevent joint and organ damage, improve function and overall well-being, and reduce long-term complications.
Use of conventional drugs and bridging strategies using glucocorticoids
Treat-to-target approach is the most important strategy for management of rheumatoid arthritis that includes the (early) use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and, if necessary, targeted synthetic or biologic DMARDs. However, csDMARDS such as methotrexate (MTX) have a delayed onset of clinical action. At the early stage of disease, structural damage may occur. That’s why, it is important to develop bridging strategies using glucocorticoids (GCs), which are fast-acting antiinflammatory drugs, also considered as disease-modifying because of their ability to decelerate structural damage.
Glucocorticoids are often used for bridging, due to the delayed action of methotrexate in active early rheumatoid arthritis. Krause et al. (2022) compared the effect of 3 bridging strategies, including high-dose and low-dose prednisolone, on radiographic and clinical outcomes. Short-term glucocorticoid bridging therapy at a high dose showed no benefit with regard to progression of radiographic damage at 1 year. They concluded that the use of short-term glucocorticoid bridging can’t provide any benefits to the structural outcome. Therefore, Krause et al. (2022) suggested that both patient and physician should consider this result before they use glucocorticoids in the treatment of early rheumatoid arthritis.
Healthy lifestyle and other measures
Besides appropriate medical treatment, healthy lifestyle and measures can manage rheumatoid arthritis and ease pain and fatigue. Diet, exercise, smoking cessation and mental health can control rheumatoid arthritis and maintain good health.
- Taking healthy foods
- Exercises: Regular low-impact exercises, such as walking, and movement
- Proper rest and breaks: It can reduce inflammation and fatigue.
- Hot and cold treatments: Heat pads or warm baths for stiff joints and tired muscles and cold treatment for acute pain and swollen joint which will numb painful areas and reduce inflammation.
- Mental support
Association of rheumatoid arthritis with coronary disease and stroke risk
Cardiovascular disease (CVD) is one of the most common diseases that causes the death of significant number of people worldwide. People with rheumatoid arthritis have more probability of having cardiovascular disease and diabetes with the rate of 1.5 times higher than the general population. The low mobility, movement and exercise are presumed to be one of the main factors for high prevalence of cardiovascular disease and diabetes mellitus. There are some more probable factors, such as shared risk factors (e.g., obesity and smoking), and side effects of antirheumatic therapies. However, the traditional risk factors do not fully support the reasons of increased rate of cardiovascular disease risk in rheumatoid arthritis. Therefore, medical research presumed that rheumatoid arthritis may be a novel and independent risk factor for coronary disease. The studies reported that cardiovascular disease and rheumatoid arthritis have overlapping pathophysiologic mechanisms which may contribute, such as systemic inflammation, with cytokines raised in rheumatoid arthritis may cause atherosclerotic diseases and cardiovascular risk in rheumatoid arthritis (Yuan et al., 2022). But there were some confusions or limitations to fully support this finding or hypothesis.
Therefore, Yuan et al. (2022) conducted a mendelian randomization analysis by using genetic variants. They concluded that genetic liability to rheumatoid arthritis was associated with elevated risk of cardiovascular disease and Intracerebral hemorrhage (ICH), but not ischemic stroke or subarachnoid hemorrhage, because genetic liability to rheumatoid arthritis was associated with elevated levels of tumor necrosis factor [TNF], and C-reactive protein [CRP], which appeared to mediate the association with cardiovascular disease. Thus, they provided important genetic evidence supporting the link between rheumatoid arthritis and some cardiovascular diseases and underscored the role of inflammation in driving cardiovascular disease specifically.
References
Arthritis foundation, 2021. Rheumatoid Arthritis: Causes, Symptoms, Treatments and More. Url: https://www.arthritis.org/diseases/rheumatoid-arthritis. Accessed on 7/10/2022.
Krause D., Mai A., Klaassen-Mielke R., Timmesfeld N., Trampisch U., Rudolf H., Baraliakos X.et al, 2022. The efficacy of short-term bridging strategies with high- and low-dose prednisolone on radiographic and clinical outcomes in active early rheumatoid arthritis: A double-blind, randomized, placebo-controlled trial. Arthritis & Rheumatology Vol. 74, No. 10, pp 1628–1637.
Yuan S., Carter P., Mason A. M., Yang F., Burgess S., Larsson S.C., 2022. Genetic liability to rheumatoid arthritis in relation to coronary artery disease and stroke risk. Arthritis & Rheumatology, Vol. 74, No. 10, pp 1638–1647.