RA Knocks the Heart Offbeat

Rheumatoid arthritis patients may have increased risk of atrial fibrillation and stroke

(RxWiki News) Joint pain is not the only thing rheumatoid arthritis patients have to deal with. The disease is linked to a number of other problems, including heart attack and heart failure.

Now, it seems it may cause other heart problems.

People with rheumatoid arthritis may have a higher risk of chaotic or irregular heart rhythms - a condition known as atrial fibrillation - compared to those without rheumatoid arthritis.

These arthritis patients are also more likely to suffer from stroke.

"Get treated for rheumatoid arthritis to protect your heart."

Past studies have shown that rheumatoid arthritis is associated with a greater risk of heart attack, heart failure and stroke. However, none of these studies looked at whether rheumatoid arthritis increases the risk of atrial fibrillation, even though atrial fibrillation is a known risk factor for heart failure and stroke.

The current study - which was conducted by Jesper Lindhardsen, M.D., of Copenhagen University Hospital Gentofte, and colleagues - is the first to ask if rheumatoid arthritis affects the risk of atrial fibrillation and stroke.

For their study, Dr. Lindhardsen and colleagues used data from over four million in the Danish population. Of these, 18,247 had been diagnosed with rheumatoid arthritis.

After following participants for five years, the researchers found that rheumatoid arthritis patients were 40 percent more likely than the general population to suffer from atrial fibrillation. Women faced a slightly higher risk than men.

On top of that, participants with rheumatoid arthritis also had a 30 percent higher risk of stroke, compared to the general population.

Recently developed guidelines recommend that rheumatoid arthritis patients get screened for heart-related risk factors such as heart attack and stroke. Yet, these guidelines do not mention screening for atrial fibrillation, as there has been no previous evidence on the topic.

According to the authors, the current study's findings suggest that rheumatoid arthritis patients should be screened for atrial fibrillation, especially because it is relatively easy to do so and because there are often no symptoms of the condition.

"Given the augmented risk of atrial fibrillation (which is often asymptomatic) and the ample opportunity for diagnosis of arrhythmia at the recommended annual screening appointments, we suggest that the clinical focus should here include screening for atrial fibrillation," they write.

Even though the study does not explain how rheumatoid arthritis may lead to these heart-related problems, the authors believe that inflammation plays a role and that controlling that inflammation should involve drugs with little cardiovascular risk.

"As inflammation is likely to play a significant role in the pathogenesis of atrial fibrillation and stroke," the authors write, "this study also underlines the importance of rigorous control of inflammation with disease modifying antirheumatic drugs, not only for the management of joint symptoms but also to reduce the need for drugs with potential adverse cardiovascular effects and, ultimately, to diminish the inflammation driven atherothrombotic process."

The research by Dr. Lindhardsen and colleagues is published in BMJ.

Review Date: 
March 15, 2012