How to Protect Your Heart From Arthritis

Inflammation linked with arthritis can raise your heart disease risk, but a healthy lifestyle and the right treatment can help protect your heart.

When you are diagnosed with rheumatoid arthritis or RA, you may be getting a double dose of bad news. RA is an inflammatory, painful form of arthritis that affects your joints. But having RA can also nearly double your risk of heart disease, some research has found.

A 2015 study published in Clinical and Experimental Rheumatology suggests there may be a way to minimize that risk, at least for some. People newly diagnosed with RA who took the medication methotrexate (Rheumatrex, Trexall) as prescribed had no greater risk of dying from heart disease over the eight-year study period than the general population, according to the researchers. They followed nearly 15,000 people who were diagnosed with RA between 2000 and 2007 in Finland.

People in the study who were on glucocorticoids, also known as steroids, did have a higher risk of dying from heart disease. So did people with a type of RA known as rheumatoid factor- or RF-positive, which is known to be linked with heart disease risk. Those who were newly diagnosed with RA who took methotrexate fared the best, however.

Methotrexate, Inflammation, and Rheumatoid Arthritis
While studies have gone back and forth about a link between RA and heart health, the Finnish study offers hope, experts say. And taking your medication as prescribed isn't the only measure you can take to reduce your risk.

The new study ''highlights the importance of treatment," says T. Jared Bunch, MD, director of heart-rhythm research at the Intermountain Medical Center Heart Institute in Murray, Utah. For many years, the primary treatment for RA was steroids. Steroids reduce inflammation quickly, Dr. Bunch says, but they also put people at risk of obesity, bone loss, and diabetes.

"Steroids are often the first-line treatment," says Bunch who is the author of the Everyday Health column Rhythm of Life, simply because they can reduce inflammation quickly.

But the study suggests methotrexate is a better medication long term. Lowering heart disease risk, Bunch says, ''is another reason to move people off steroids, if possible, as soon as possible.''

The study findings make sense, says Susan Goodman, MD, associate director of the Inflammatory Arthritis Center at the Hospital for Special Surgery in New York City. "Disease-modifying drugs such as methotrexate or TNF-inhibitors, which alter the natural progression of the disease, can directly decrease the body's inflammatory burden," says Dr. Goodman.

Having RA is like having a fire inside you, says Mahsa Tehrani, MD, a rheumatologist at the Arthritis & Rheumatology Clinical Center in Vienna, Virginia. "The more you put it out and the earlier, the better," says Dr. Tehrani. "The earlier you treat, the more likely a remission, and remissions can be long term."

Heart Disease Risk in RA, Psoriatic Arthritis, and Ankylosing Spondylitis
While some research has found a negative effect of RA on heart health, "more and more studies show early use and consistent use of disease-modifying medications normalize the cardiac risk," Goodman says. That's the bottom line of the new Finnish study.

However, other research also continues to show an increased risk of heart disease overall in people with RA. For instance, researchers who evaluated nearly 10,000 women with RA found they had a 1.5 to 2.5 increased risk of heart disease.

The heart disease risk also applies to ankylosing spondylitis — a form of inflammatory arthritis that mainly affects the spine and back — and to psoriatic arthritis as well. Canadian researchers found that having ankylosing spondylitis boosts the risk of heart disease by 25 percent to 60 percent, especially in those ages 20 to 39.

In another study of nearly 200 people with psoriatic arthritis, researchers found that having the arthritis was linked with cardiovascular disease even in the early stages of arthritis.

More Ways to Protect Your Heart Health
Despite the increased risks found by some researchers, if you have RA, ankylosing spondylitis, or psoriatic arthritis, you can take several measures to reduce your risk of heart disease. Besides taking disease-modifying medications if indicated, you can:

1.Lose excess weight. Some experts suggest that those with RA and other forms of inflammatory arthritis should aim for an even lower body mass index, or BMI, than what is suggested for others, Goodman says. (Generally, a BMI of 25 is termed overweight.

You can calculate your BMI.) However, getting to a BMI less than 25 is hard for some. So, instead of focusing on a weight that seems difficult to achieve, Tehrani tells her patients just to try to get to a healthier weight.
2.Eat a healthier diet. Tehrani tells patient to focus on fruits, vegetables, and natural, organic foods.
3.Do not smoke. "Smoking is a huge problem for RA," Goodman says, because it boosts inflammation.
4.Keep an eye on cholesterol. Get your doctor's advice about the best cholesterol levels for you and advice about how to get them to healthy levels or maintain healthy levels.

5.Monitor blood sugar levels, Bunch says. That will help you avoid diabetes, which automatically raises heart disease risk.
6.Be aware of heart disease warning signs, such as chest pain, but be aware that sometimes cardiac disease is silent, with no symptoms, Goodman says. That makes it all the more important to monitor your cholesterol and other measures of heart health.