In rheumatoid arthritis (RA), the immune system attacks the joints and leaves them sore, swollen, and stiff. But RA is more than a joint disease. It also affects other parts of your body, including your heart.
Having RA nearly doubles your risk for heart disease. It also increases your risk for a stroke, which happens when a blood vessel that carries oxygen and nutrients to your brain becomes blocked or bursts.
Knowing your stroke risk is important. Stroke is one of the main causes of death and disability in the United States. A stroke can affect your speech, memory, and movement.
If you're at risk of stroke because of RA, weight gain, high blood pressure, or other factors, know that there are things you can do right now to help prevent a stroke.
What's the Connection?
There are a few possible reasons for the link between RA and stroke.
RA increases the risk for stroke, but osteoarthritis (OA) doesn't. What's the difference between these two types of arthritis? Inflammation. RA causes inflammation all over your body. In OA, the inflammation is only in the joint.
When you have RA, your immune system attacks your joints. That attack releases inflammatory chemicals called cytokines that damage your joints and cause symptoms like swelling and pain.
RA doesn't stop at your joints, though. Those same inflammatory cells damage your blood vessels.
Inflammation makes your blood cells stick together and form clots. It also speeds the buildup of plaques on artery walls, called atherosclerosis. Those plaques narrow blood vessels and block the flow of blood, which increases your risk for a heart attack or stroke.
RA also damages heart valves and increases the risk for atrial fibrillation (Afib). This irregular heart rhythm makes you three to five times more likely to have a stroke caused by a blood clot.
Shared risks
People with RA are more likely to also have these risk factors that increase the chance of having a stroke:
Obesity. Sore joints make it harder to exercise. A lack of exercise can lead to weight gain. Steroid medicines used to treat RA also promote weight gain. When you're overweight, the extra fat cells release substances that promote inflammation and add to your heart disease risks.
High blood pressure. People with RA have less flexible arteries that can't widen enough to let more blood through. Narrow arteries lead to high blood pressure. Nonsteroidal anti-inflammatory drugs (NSAIDs) used for pain relief and steroid medicines used for inflammation in RA can also raise blood pressure.
Metabolic syndrome. This cluster of conditions that includes high blood pressure, obesity, high cholesterol and triglycerides, and high blood sugar increases the risk for stroke. Almost 40 percent of people with RA have metabolic syndrome, compared to 20 percent of people in general.
Smoking. Along with the damage smoking does to your lungs, it increases your risk for RA. And once you have RA, smoking speeds joint and blood vessel damage. Smokers with RA are 50 percent more likely to have a heart attack or stroke than nonsmokers with RA.
Medication
Some of the medicines that treat RA inflammation and pain can increase the risk of heart disease and stroke. One is NSAIDs, which includes diclofenac, ibuprofen, and naproxen. Celecoxib (Celebrex) might not increase the stroke risk as much, but this still has to be proven.
The increased heart risks start soon after you start taking an NSAID and rise the longer you take these medicines. If you need an NSAID for RA pain relief, ask your doctor if you can take the lowest possible dose needed to control your symptoms.
Corticosteroids also increase heart risks. This may be because they cause weight gain and they raise cholesterol and blood sugar levels.
Who Gets a Stroke?
Strokes often affect people older than 65. But with RA, your risk goes up before age 50.
Having a serious illness might increase your chance of having a stroke. One study found a higher risk of stroke in the 30 days after a serious infection or hospital stay. Lying in bed while you're sick increases the risk for blood clots, which can lead to a stroke.
You're also more likely to have a stroke if you smoke or you have:
- High blood pressure
- Diabetes
- Heart disease
- Heart failure
- Atrial fibrillation
Get a Heart Screening
Most people with RA don't know their heart disease risks. Once you know that you're at risk, you can get treatment to prevent a stroke.
Ask your doctor whether you need a heart disease risk assessment. This screening test estimates your odds of having cardiovascular disease over the next 10 years based on risks like your:
- Age
- Blood pressure
- Cholesterol level
- Smoking history
Your doctor can put together a prevention plan for you based on the results.
What You Can Do
The first thing to do is get your RA under control. Disease-modifying antirheumatic drugs (DMARDs) bring down inflammation in your body. Starting on one of these medicines as soon as possible will protect both your joints and your heart.
Your doctor might choose a DMARD like methotrexate or a tumor necrosis factor (TNF)-alpha inhibitor because these drugs also help to lower the risk for heart disease.
If you have heart disease or you're at risk for it, be careful when using steroids or NSAIDs. Take the lowest possible dose of these medicines for the shortest amount of time needed to control your joint symptoms.
Here are a few other ways to protect your heart:
Quit smoking. Ask your doctor about medication, nicotine replacement products, or counseling to help you stop.
Watch your numbers. Get regular checks of your blood pressure, blood sugar, and cholesterol levels. Ask your doctor how often you should get tested. Keep these numbers in a healthy range with diet, exercise, and medication, if you need it.
Eat a heart-healthy diet. Limit saturated fat. Eat more fatty fish like salmon and tuna, which contain inflammation-lowering omega-3 fatty acids.
Exercise. Do aerobic and strengthening exercises on most days of the week. Exercise helps you lose weight, brings down inflammation in your body, and protects your blood vessels.
Explore other kinds of pain relief. Try to limit NSAIDs to the smallest dose needed to control your pain. Instead, try heat, cold, or physical therapy.
Spotting the Warning Signs
Call your doctor, 911, or go to an emergency room right away if you have stroke symptoms like these:
- Numbness or weakness in your face, arm, or leg
- Confusion, trouble speaking or understanding speech
- Trouble seeing in one or both eyes
- Dizziness, loss of balance, trouble walking
- Sudden, severe headache with no obvious cause
