Heart Skull

Heart Skull

Rheumatoid arthritis (RA) is a chronic, progressive, systemic autoimmune disease for which there is no current treatment. This a common disorder that affects more than 2.1 million Americans.

Patients with complications of RA outside the joints, what we call extra-articular disease are particularly at risk of premature death. Extra-articular problems that can be seen in RA include skin ulcers, anemia, eye inflammation, lung inflammation and damage, heart disease, inflammation of blood vessels, and rheumatoid nodules (bumps are formed by the inflamed tissue that grow in certain areas such as fingers, elbows, heels, and back skull).

A predictor of the presence of extra-articular disease is the rate of rheumatoid factor in blood. More rheumatoid factor, plus likelihood a patient will have extra-articular disease.

A marker for new blood, anti-CCP (anti-cyclic citrullinated peptide), appears also predict a higher risk of extra-articular problems as disease and the most severe.

The bottom line is that RA is not a benign condition. In fact, it carries the same mortality as the first heart attack, untreated diabetes and Hodgkins disease stage 4 in some studies. RA should be diagnosed and treated aggressively.

Probably the main cause of increased mortality cardio-vascular death. Estimates range from 33-50% of all deaths in patients with RA are due to cardiovascular causes. Patients with RA have increased significant risk of atherosclerosis, congestive heart failure, heart attack, and vasculitis (inflammation of blood vessels).

So what are some risk factors that are particularly important?

Among these are:

• Sickness Severe RA

• Severe extra-articular disease

• high blood levels of homocysteine, which is aggravated by treatment with methotrexate

• Abnormalities of the blood vessel wall

• Drugs that are used to treat rheumatoid arthritis such as corticosteroids and non-steroidal anti-inflammatory

• Overproduction of inflammatory cytokines (chemical messengers of the disease)

• Rheumatoid nodules

A note about drugs ...

Methotrexate, the most commonly used disease-modifying anti-rheumatic of the drug is associated with a significant reduction in the incidence of cardiovascular death. Unfiortuantely, nonsteoridal anti-inflammatory drugs that are commonly used to treat the symptoms of RA increase the risk of blood clots, cardiovascular disease, and congestive heart failure.

The role of other medical problems such as blood sugar, elevated lipids, and so on are a topic for another article.

Recommendations reducing cardiovascular risk in patients with RA include:

• low dose aspirin (which should be supplemented by a some kind of protection of the stomach), particularly in patients taking anti-inflammatory drugs.

• Statin drugs for people with high lipid

• Supplementation with folic acid to reduce homocysteine levels seen in RA

• Attention to the use of TNF inhibitors - in patients with congestive heart failure

• Control of co-morbid conditions, such as smoking, diabetes and hypertension that may exacerbate the tendency to cardiovascular risk.

Complicate this question, some data show that TNF blockers can raise serum lipids in some cases. The implications of this phenomenon on the overall picture is still unknown.

A bright note: there is growing evidence that aggressive treatment with methotrexate and TNF-reduced the incidence of cardiovascular events. Therefore, the above problem lipids May not be very important. Further studies are obviously necessary to confirm these results.

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