Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting the joints, leading to pain, swelling, and potential deformity. Beyond the joints, RA is a systemic condition, meaning it can impact various other organs and systems throughout the body. This widespread inflammation can significantly increase the risk of certain health complications that contribute to mortality. Understanding these risks is important for individuals living with RA and for healthcare providers managing the condition.
The Leading Cause
Cardiovascular disease (CVD) is the most common cause of death in individuals with rheumatoid arthritis. This includes heart attack, stroke, and heart failure. People with RA face a substantially higher risk of developing CVD compared to the general population, even when accounting for traditional cardiovascular risk factors.
Studies indicate that RA patients are almost twice as likely to develop heart disease. The risk of cardiovascular events in RA patients can be comparable to that seen in individuals with diabetes. This highlights the profound impact RA has on cardiovascular health, making it a primary concern.
How Rheumatoid Arthritis Increases Risk
Chronic inflammation, a hallmark of rheumatoid arthritis, plays a central role in elevating cardiovascular risk. The persistent systemic inflammation in RA directly contributes to the development and acceleration of atherosclerosis, which is the hardening and narrowing of arteries. This inflammation also leads to endothelial dysfunction, impairing the inner lining of blood vessels and promoting plaque buildup.
RA patients may also experience traditional cardiovascular risk factors, which can be intensified by their condition or its treatments. These include high blood pressure, high cholesterol, diabetes, and obesity. For instance, high blood pressure is common in RA and can be exacerbated by inflammation and certain medications.
Some medications used to manage RA, while essential for controlling disease activity, can affect cardiovascular health. Corticosteroids, for example, may influence blood pressure or lipid profiles. Additionally, joint pain and stiffness from RA can significantly reduce physical activity levels, further contributing to an increased risk of CVD.
Other Significant Mortality Factors
While cardiovascular disease is the leading cause of death, other factors also contribute to increased mortality in individuals with rheumatoid arthritis. Infections pose a significant threat, as RA patients often have a compromised immune system due to the disease and immunosuppressive medications. This heightened vulnerability increases the risk of serious infections, including bacterial, respiratory, and bloodstream infections.
Respiratory diseases are another concern, with RA patients facing an increased risk of lung complications. Interstitial lung disease (ILD), where scar tissue forms in the lungs, is particularly prevalent and can be a serious cause of morbidity and mortality.
RA patients also have a slightly increased risk of certain cancers, particularly lymphomas. Kidney complications can also contribute to mortality in RA. Chronic kidney disease is more common in RA patients, with inflammation and accelerated atherosclerosis also playing a role.
Improving Patient Outcomes
Aggressive management of rheumatoid arthritis disease activity is important to reduce systemic inflammation. Controlling inflammation also helps mitigate cardiovascular risks. Regular monitoring of disease activity using clinical assessments and laboratory tests helps guide treatment adjustments.
Vigilant screening and management of traditional cardiovascular risk factors are crucial for RA patients. This includes regularly checking and addressing blood pressure, cholesterol levels, and diabetes. Some RA medications, like methotrexate and TNF inhibitors, may also have a protective effect against cardiovascular events by reducing inflammation.
Adopting healthy lifestyle modifications can also improve outcomes. This encompasses maintaining a healthy diet, engaging in regular physical activity as tolerated, and encouraging smoking cessation, which is a major risk factor for both RA severity and cardiovascular disease.
Infection prevention strategies, such as appropriate vaccinations, are important given the increased susceptibility to infections in RA patients. Prompt treatment of any infections is also necessary. Regular medical check-ups and screening for potential complications are vital for early detection and intervention, contributing to better overall patient outcomes.