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Rheumatoid arthritis (RA) is a chronic, progressive, systemic autoimmune for which there is no current cure. It is a common disorder that affects more 2.1 million Americans.
Patients with complications of RA outside the joints, so-called extra-articular, are at particular risk premature death. Extraarticular problems that can be seen in rheumatoid arthritis include skin ulcers, anemia, eye inflammation, inflammation of the lungs and damage, heart disease, blood vessel inflammation and rheumatoid nodules (these are blows to the inflamed tissue is growing in certain areas such as fingers, elbows, heels and back of the skull).
A predictor of the presence of extra-articular disease is the level of rheumatoid factor blood. The higher the rheumatoid factor is more likely that a patient has an extra-articular disease.
A more recent blood marker, anti-CCP (against cyclic citrullinated peptide) also appears to predict increased risk of extra-articular problems as disease and more serious.
The conclusion is that RA is not a benign condition. In fact, carries the same mortality as heart attacks first, untreated diabetes, and stage 4 Hodgkin's disease some studies. RA should be diagnosed and treated aggressively.
Probably the main cause of increased mortality is cardiovascular death. Estimates range between 33-50% of all deaths in patients with RA are due to cardiovascular causes. Patients with RA have a significantly increased risk for atherosclerosis, heart failure failure, heart attack, and vasculitis (inflammation of blood vessels).
What are some risk factors that are particularly important?
They include:
• Severe RA disease
• Severe extra-articular
• Levels Elevated blood homocysteine, which is exacerbated by therapy with methotrexate
• Abnormalities of blood vessel walls
• The drugs used to treat RA, such as corticosteroids and NSAIDs
• The overproduction of inflammatory cytokines (chemical messengers of the disease)
• Rheumatoid nodules
A note about drugs …
Methotrexate, the most commonly used disease-modifying anti-rheumatic drugs is associated with a significant reduction in the incidence of cardiovascular death. Unfiortuantely, nonsteoridal anti-inflammatories, which are commonly used to treat the symptoms of rheumatoid arthritis increases the risk of blood clots, cardiovascular disease and inadequate heart failure.
The role of other medical problems such as blood sugar, elevated lipids, etc., are a topic for another article.
Recommendations for reducing cardiovascular risk in patients with rheumatoid arthritis include:
• Low-dose aspirin (to be completed with some protection from stomach), especially in patients taking NSAIDs.
• Statin drugs for people with high lipid levels
• Folic acid supplements to minimize elevated homocysteine levels seen in the AR
• Caution with the use of TNF inhibitors – in patients with congestive heart failure
• Control of comorbid conditions, such as smoking, diabetes and hypertension that might aggravate the tendency to cardiovascular risk.
Complicating the matter is some data showing that TNF inhibitors may increase serum lipids, in some cases. The implications of this phenomenon on the overall picture remains unknown.
A note positive: there is increasing evidence that aggressive treatment with methotrexate and TNF inhibitors reduce the incidence of cardiovascular events. Therefore, the problem mentioned lipid can not be so important. Further studies are clearly needed to confirm these findings.
About the Author:
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info:
Arthritis Treatment
Article Source: ArticlesBase.com – What Are The Risks For Heart Disease From Rheumatoid Arthritis?
