Joint pain, swelling, fatigue, and stiffness are some of the many symptoms and effects of rheumatoid arthritis (RA) and they are hard to deal with or ignore. To add to these challenges, having RA can lead to other serious consequences that may not be as obvious, such as heart disease.

Heart disease is a common cause of death in people with rheumatoid arthritis. People with rheumatoid arthritis have a 50 percent higher risk of having heart troubles than those without RA. It is hard to pinpoint the exact cause for this, but what is clear is that inflammation caused by RA, increases the risk for heart disease.

Let’s look at some measures you can take to minimize the risk for heart disease.

Manage Your RA Well

Studies show that when people with RA keep their disease under control, their risk for heart disease is similar to those without RA. So essentially, the risk decreases with better management of the RA. It also seems that when the RA is under control, other things improve as well; blood pressure goes down (high blood pressure is a risk for heart disease) and the good cholesterol goes up. Additionally, research has repeatedly shown that methotrexate, when taken consistently, decreases the chance of getting heart disease by 50 percent. Not too bad for good old methotrexate. The use of other therapies for RA, like hydroxychloroquine and anti-TNF inhibitors, are also associated with decreased risk of heart disease which further supports that managing your RA well and taking your medications consistently are important for heart health.

Ironically, other medications used for RA symptoms can increase the risk of heart disease, particularly NSAIDs including ibuprofen, diclofenac, and others, have been associated with nearly a 25 percent increase in heart disease. Similarly prednisone and other glucocorticoids may also increase the risk. Only use these drugs when needed, and at the lowest dose possible, to relieve symptoms is particularly relevant to decrease risks.

Exercise and Don’t Smoke

In an experiment with 40 individuals with RA, half of them were assigned to do exercise and the other half to continue their normal levels of physical activity. Those assigned to the exercise group decreased their blood pressure and decreased their heart disease. Not only that, but they also saw improvements with their RA.

In addition to regular exercise, not smoking is critical for maintaining a healthy heart. Smoking cessation also helps prevent inflammation and helps to keep RA under control. Talk about killing two birds with one stone.

Manage Other Chronic Diseases

Diabetes, high cholesterol, and high blood pressure are the triple whammy of heart disease as they directly impact the health of the heart. Getting medical treatment for these conditions will help control any additional risks for heart disease.

Having to worry about heart health while having rheumatoid arthritis adds to the burden of the disease, but on the bright side, by managing the RA well, you will also be taking good care of your heart.

These are just a few suggestions to help you manage your rheumatic disease and any related cardiovascular concerns. As always, speak with your rheumatologist to answer any questions you may have.


Dr Ali GarciaAli Duarte-Garcia, MD is a Fellow in the Division of Rheumatology at the Mayo Clinic in Rochester, MN. He most recently served on the American College of Rheumatology’s Communications and Marketing Committee.