by Caitlin Seida from In The Cloud Copy

As if rheumatoid arthritis (RA) weren’t painful enough, those living with the disorder also have to pay extra attention to their hearts – those with rheumatoid arthritis are high risk when it comes to cardiovascular disease. A good team of doctors, regular screening, and a keen eye on cardiovascular health can help spot problems at the onset or before. But not every doctor is on the same page when it comes to their patients’ health outcomes.

An unfortunate but unsurprising revelation in a study published in the June 3, 2020 edition of the medical journal Nature Review Rheumatology reveals a startling lack of preventative care and treatment for those with both RA and cardiovascular illness and calls for an examination of screening tools and risk calculation models to better serve those living with rheumatoid arthritis who are also at risk for cardiovascular problems.

The Link Between Rheumatoid Arthritis and Cardiovascular Disease

Inflammation plays a major role in both RA and cardiovascular disease. Rheumatoid arthritis is an inflammatory condition affecting the joints. While inflammation alone isn’t responsible for heart disease or issues, it contributes to the development and worsening of cardiovascular disease. The link is so strong that it’s been a known fact for several decades that RA is a predisposing factor in the development of:

• Atherosclerotic cardiovascular disease
• Stroke
• Heart failure
• Arrhythmias
• Several other cardiovascular health issues

Screening measures for cardiovascular health take into account a number of lifestyle factors but often overlook the presence of rheumatoid arthritis and the effect of treatment for RA on cardiovascular disease despite the prevalent and increased risk.

Screening Measures for Cardiovascular Disease

Although risk calculation and prediction models exist for the general public, they do not take into account the added potential for cardiovascular problems among those living with rheumatoid arthritis. As of 2020, there are no guidelines for regular screening measures for preventing cardiovascular disease in those with RA in the United States. This is in stark contrast to Europe, where the European League Against Rheumatism (EULAR) recommends a screening every five years.

While mathematical calculations fail patients with rheumatoid arthritis, ultrasounds of the carotid arteries allow doctors to visualize whether plaque is present. The EULAR recommends this, while in the USA there is no standard practice for the use of diagnostic radiology; this is potentially hampered by the cost of routine screenings, access to proper equipment in certain areas, and unfamiliarity with the need for visualization of the arteries to detect asymptomatic predictors of heart disease in patients living with RA.

What Can Be Done

Current rheumatoid arthritis measurements regularly record factors like age, sex, and whether or not an individual is a smoker. Rheumatologists could increase the odds of catching cardiovascular issues by routinely recording blood pressure and blood lipid measurements in patient records to spot trends over time or use one of the prediction models in-office, despite flawed calculation measures.

Additionally, regular ultrasonic imaging could improve outcomes of cardiovascular disease in those with RA, if implemented and followed up on in a timely manner.

Recommendations

Most often the first signs of potential heart problems in those with rheumatoid arthritis are the same as those without: high cholesterol levels are detected via blood test or high blood pressure is detected during office visits. When this occurs, folks with rheumatoid arthritis receive a similar treatment protocol as the general public, with the first line often being diet and lifestyle change, as well as the addition of lipid- or blood pressure-lowering medications.

Unless cardiologists, general practitioners, rheumatologists, and pharmacists are well-versed on both conditions, specific drug interactions can cause problems in the co-commitment treatment of cardiovascular disease and RA. Even with the few known interactions that necessitate modified dosages of certain drugs, it’s still a big unknown if medications for RA have any significant impact on therapies for cardiovascular disease.

By knowing about the increased risk of cardiovascular diseases that comes with a diagnosis of rheumatoid arthritis, it’s easier to be your own advocate when pushing for routine cardiovascular checkups and screening. It’s important to keep the lines of communication open between your doctors and make sure everyone is on the same page regarding your risks, screening, and any treatment that may be necessary.