|
Stories for Reprint
Doctors Urge More Aggressive Cardiac Screening for People with Rheumatoid Arthritis
By Ekaterina Pesheva
If you have rheumatoid arthritis, listen to your heart. This is what doctors are urging people who have the disease to do, after two Mayo Clinic studies found that rheumatoid arthritis ups one's risk for heart failure, heart disease and sudden cardiac death.
About 2 million people in the United States have rheumatoid arthritis, an autoimmune disease that causes inflammation, pain and damage to the joints.
Researchers are not sure why and how people with rheumatoid arthritis develop heart disease, and there are no recommendations for prevention and treatment at this time. So what is a person with rheumatoid arthritis to do?
"When studies like these come out, they should increase our awareness that we need to look beyond joint pain and stiffness in people with rheumatoid arthritis and start thinking about heart disease," says Michael Lim, M.D., assistant professor of cardiology at St. Louis University.
Doctors suspect that the inflammation caused by rheumatoid arthritis is the most likely culprit.
"While the exact mechanism remains unknown, there is enough anecdotal evidence to suggest that the inflammation caused by rheumatoid arthritis damages the arteries," Lim says.
In fact, doctors now can measure the level of inflammation in the body by gauging levels of an enzyme called CRP, C-reactive protein. Elevated levels of CRP are associated with increased heart disease risk in everyone, not just people with rheumatoid arthritis. CRP testing, while not used regularly as a screening tool for heart disease, has a reliable predictive power and is beginning to gain more mainstream diagnostic popularity, Lim says.
People with rheumatoid arthritis who have elevated CRP levels and borderline cholesterol levels might benefit from treatment with statins, a class of drugs that lower cholesterol and also have been shown to curb inflammation, Lim says.
Everyone who has been diagnosed with rheumatoid arthritis, regardless of age and the severity of the disease, should have a serious discussion with a primary care physician about screening and testing for heart disease even if they do not have symptoms or traditional risk factors, such as family history, high blood pressure, diabetes and high cholesterol. Researchers found that people with rheumatoid arthritis can develop heart disease even in the absence of these factors.
"In general, people with rheumatoid arthritis develop heart disease earlier in life, so we should lower the age where we start to think about heart disease," Lim says.
The Mayo Clinic studies found that about one-third of the patients who were studied developed heart failure over a 30-year period. Heart failure is caused by weakened of heart muscle, which prevents the heart from pumping blood. Symptoms include fatigue, shortness of breath, persistent cough, swelling of the legs, ankles and abdomen due to water retention, sudden weight gain (three or more pounds in one day, five or more pounds in one week). The risk of heart failure increases soon after the onset of rheumatoid arthritis and remains constant throughout the course of the disease, the study found. People with rheumatoid arthritis are also more likely to experience fewer symptoms, silent heart attacks and sudden cardiac death than people without rheumatoid arthritis, researchers found.
For a full text of the studies, go to http://www3.interscience.wiley.com/cgi-bin/fulltext/109891878/HTMLSTART AND TO http://www3.interscience.wiley.com/cgi-bin/fulltext/109891899/HTMLSTART
|
|
