Rheumatoid Arthritis more than a diseases of joints

Rheumatoid Arthritis more than a diseases of joints

An autoimmune disease is a condition in which your immune system mistakenly attacks your body. ... In an autoimmune disease, the immune system mistakes part of your body, like your joints or skin, as foreign. It releases proteins called autoantibodies that attack healthy cells. Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels.  Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities. Among the serious complications people with rheumatoid arthritis (RA) experience, cardiovascular disease heads the list. Having RA doubles, the risk of most heart problems, including heart attack, stroke and atherosclerosis — the buildup of fat, cholesterol and cellular debris (plaque) on blood vessel walls. 

Daniel H. Solomon, MD, a professor at Harvard Medical School in Boston and a leading researcher on cardiovascular disease and RA, says the inflammatory processes in RA and heart disease are very similar. In RA, inflammation attacks the synovium — the thin layer of tissue that lines your joints — but it can move to other organs, including the heart. One of the possible victims is the endothelium, the innermost layer of blood vessels. Inflammation causes damage to the blood vessel lining, and plaque builds up. This fatty deposit narrows arteries, raising blood pressure and reducing the flow of blood to your heart and other organs.

Making sense of how inflammation and other risk factors influence RA-related heart disease will help doctors identify and treat high-risk patients early, before they develop symptoms. The challenge is that current cardiovascular risk assessments, which use medical history and lifestyle information to predict a person’s five-year risk of heart disease, aren’t very useful for RA patients. For one thing, standard risk assessments don’t factor in the effects of inflammation or medication.

“Right now, the Holy Grail is finding a better risk assessment,” says Dr. Solomon. In the May 2015 issue of Arthritis and Rheumatology, he and his colleagues published an expanded and validated risk assessment specifically for RA. In addition to traditional cardiovascular risk factors, they also included RA disease activity, disability, prednisone use and years with RA. The researchers found the expanded assessment improved classification of risk compared with traditional risk assessments.