Systemic inflammation increases the risk cardiovascular disease in patients with rheumatoid arthritis further increasing the risk of death. Researchers from Mayo Clinic in Rochester, Minnesota found that the rate of illness and death from cardiovascular disease is higher among rheumatoid arthritis patients, and there is increasing evidence that inflammation plays a key role in the development of atherosclerosis, also known as hardening of the arteries. The researchers investigated if evidence of severe inflammation in rheumatoid arthritis patients might be associated with an increased risk of death from cardiovascular disease. They looked at 603 patients with rheumatoid arthritis, representing all residents of Rochester 18 years or older who were diagnosed with rheumatoid arthritis between 1955 and 1995. Study subjects were followed for an average of 15 years. The researchers found a number of factors and other illnesses increased the risk of cardiovascular death, including personal history of cardiovascular disease, high blood pressure, diabetes mellitus, cancer and history of alcoholism. After accounting for these factors, the researchers found that three markers of inflammation were independently associated with a greater risk of cardiovascular death. These included having at least three high erythrocyte sedimentation rate (ESR) tests; rheumatoid arthritis vasculitis; and rheumatoid lung disease. Swelling of large joints also was associated with a greater risk of cardiovascular death. It was also found that corticosteroid use increased the risk of cardiovascular death among rheumatoid arthritis patients who had no history of heart disease, but reduced cardiovascular death risk among those had a history of heart disease. While these drugs promote high blood pressure and high cholesterol, their anti-inflammatory effects may benefit patients with existing heart disease. More investigations are needed to find whether aggressive treatment to tightly control systemic inflammation in rheumatoid arthritis patients can reduce the risk of cardiovascular death similar to the benefits of tightly controlling blood sugar levels in diabetics.
Arthritis and Rheumatism,
April 2005