Early remission can minimise the risk of developing heart disease

Rheumatoid arthritis is associated with heart disease, and each disease flare has an additive effect. But achieving early remission may reduce the risks.

Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints and sometimes their internal organs, causing pain and disability. Many studies have suggested that treatment and interventions should target disease in the early stages to help prevent disability and long-term damage to the joints. People with rheumatoid arthritis have an increased risk of suffering from cardiovascular diseases such as heart attacks and stroke. This is because the inflammation involved in rheumatoid arthritis can have an effect on other systems in the body, as well as the joints.

Although it is known that cardiovascular risk is increased in patients with rheumatoid arthritis compared to people without the disease, it is not known whether changes in disease activity affect the relationship. The authors aimed to assess whether disease activity flares and remission change the risk of developing cardiovascular disease.

The study included 525 patients with rheumatoid arthritis and 524 people without the disease (controls). All patients were at least 30 years old and had no history of previous cardiovascular disease.

This was a retrospective study. This means that the authors reviewed the medical records of each person included to define whether they were flaring or were in remission at each of their clinical visits, starting from the onset of their disease until they either died, moved away, or the end of the study in 2012. On average, there were 10 years of records. Patient records were also screened to see if there was any information recorded that suggested the development of heart disease – for example, myocardial infarction (heart attack), angina or death from heart disease or heart failure. The authors then assessed whether patients who experienced more flares of their rheumatoid arthritis were more likely to develop heart disease than those who spent more time in remission. The risk of heart disease in patients with rheumatoid arthritis was also compared to people without the disease.

The authors found that the overall risk of developing heart disease was twice as high in people with rheumatoid arthritis compared to those without. Each flare of rheumatoid arthritis increased the risk of heart disease by 7% compared to time spent in remission. Importantly, people in remission and those who achieved early remission within the first year of their initial diagnosis of rheumatoid arthritis had similar risks of developing heart disease as people without rheumatoid arthritis. However, people who did not achieve early remission had a 38% increased risk of developing cardiovascular disease compared to people without rheumatoid arthritis.

This study found that cardiovascular risks increase over time in people with rheumatoid arthritis, even if there is a decrease in the number of flares and an improvement in disease activity and severity. This study is among the first to show that flares of rheumatoid arthritis have an irreversible and damaging effect on cardiovascular risk, and that early remission may protect people from developing heart disease.

The main limitation of the study is that is relied on information collected from medical records, which could mean that the ‘flare’ or ‘remission’ categories were not always recorded accurately or in the same way by different doctors. Also, it was not possible to work out whether remission was achieved by treatment, or if it was spontaneous ( just naturally happened), and if these different types of remission might have an effect on the risk of developing heart disease. However, this is not thought to have a significant impact, and the authors are confident that the results are reliable.

Further studies are underway to work out how to best manage disease flares in people with rheumatoid arthritis.

If you have rheumatoid arthritis, it is important to manage and look after your disease carefully. Your doctor may talk to you about ‘treat to target’ strategies that are designed to help you achieve your goals quickly. Starting treatment soon after you are first diagnosed with rheumatoid arthritis can help to minimise the risk of developing heart problems. It is important that you continue to take any medicines you are prescribed for your rheumatoid arthritis, even if you feel well, and do not stop taking your treatment without talking to your doctor first. As well as improving the function in your joints and reducing pain and disability, achieving remission may help you to avoid developing other complications such as heart disease. Disease flares should be monitored and looked after by your doctor.

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Date prepared: March 2016

Summary based on research article published on: 30 January 2015

From: Myasoedova E. et al. The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease. Ann Rheum Dis 2016;75:560–65. doi:10.1136/annrheumdis-2014- 206411

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