Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder that affects more than 1.3 million people in the United States alone.

This debilitating condition primarily targets joints, leading to pain, swelling, and stiffness that can impair mobility and diminish overall quality of life. While the exact cause of RA remains unknown, a combination of genetic, environmental, and lifestyle factors are thought to contribute to its development.

While there is no cure for RA, medications are available that can alleviate symptoms and slow the progression of the disease.

Commonly prescribed medications for RA include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologic agents. Unfortunately, these therapies can have dangerous side effects on the cardiovascular system that can lead to serious health complications in some patients.

Cardiovascular Risks of Rheumatoid Arthritis Medications

Several studies have demonstrated that individuals with RA have an increased risk of cardiovascular disease (CVD) compared to those without the condition.

This increased risk is thought to be partially due to inflammation associated with RA, as chronic inflammation can damage arteries and promote plaque buildup that can narrow and harden blood vessels, increasing the risk of heart disease and stroke.

Despite this increased risk, RA patients are often prescribed medications that can further exacerbate their cardiovascular risks.

For example, some NSAIDs, such as naproxen and ibuprofen, have been shown to increase the risk of heart attack and stroke in patients with or without pre-existing CVD.

Corticosteroids, which are often used to suppress inflammation in RA patients, can also have harmful effects on the cardiovascular system.

In high doses and over long periods of time, corticosteroids can increase blood pressure, promote insulin resistance, and lead to weight gain. These effects can increase the risk of CVD and potentially worsen existing cardiovascular conditions in RA patients.

DMARDs are another class of RA medications that have been shown to increase cardiovascular risk in some patients.

Methotrexate, a commonly prescribed DMARD, has been shown to cause elevations in blood pressure and heart rate, and has been associated with an increased risk of cardiovascular events such as heart attack and stroke.

Thromboembolism Risks of Rheumatoid Arthritis Medications

Another important cardiovascular risk associated with RA medications is the increased risk of thromboembolism.

Thromboembolism occurs when a blood clot forms in a vein, typically in the legs or arms, and then travels through the bloodstream to block blood flow in another part of the body.

Corticosteroids, which are known to increase the risk of blood clotting, have been shown to increase the risk of thromboembolism in RA patients.

Biologic agents, which are a newer class of RA drugs that work by targeting specific inflammatory pathways, have also been associated with an increased risk of thromboembolism. Specifically, certain biologics that inhibit TNF-alpha, such as infliximab and adalimumab, have been shown to increase the risk of blood clots in some patients.

The risk of thromboembolism associated with RA medications can be further compounded by other pre-existing health conditions or risk factors, such as smoking, obesity, and certain genetic mutations that affect blood clotting.

Reducing Cardiovascular Risks in RA Patients

Despite the known cardiovascular risks associated with RA medications, it is important for patients with RA to continue taking their prescribed medications as directed to manage their symptoms and slow the progression of their disease.

However, there are steps that patients and healthcare providers can take to minimize cardiovascular risks associated with RA medications.

One important step is to monitor cardiovascular health and risk factors, such as blood pressure, cholesterol levels, and smoking status, regularly.

If a patient has pre-existing CVD or other cardiovascular risk factors, healthcare providers may recommend alternative medications or lower doses of medications to reduce cardiovascular risks.

Patients can also make lifestyle changes to reduce the risk of CVD associated with RA.

These changes may include quitting smoking, adopting a heart-healthy diet, engaging in regular physical exercise, and managing other cardiovascular risk factors, such as high blood pressure and high cholesterol.

Conclusion

Rheumatoid arthritis is a complex and challenging disease that requires careful management and treatment to reduce inflammation and preserve joint function.

While medications can be effective in achieving these goals, they can also have dangerous side effects on the cardiovascular system that can increase the risk of heart disease, stroke, and thromboembolism. It is important for patients with RA to work closely with their healthcare providers to monitor cardiovascular risks and develop strategies for reducing these risks while still effectively managing the disease.