Number of Years with Arthritis Not Tied to Heart Troubles

Rheumatoid arthritis and heart disease connection not tied to RA disease duration

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Inflammation in arthritis clearly causes joint pain, but it has been tied to heart troubles too. A new study explored if more time with arthritis might affect the risk for heart issues.

This study, which spanned two decades, looked at rheumatoid arthritis patients in The Netherlands and cases of heart problems.

The researchers found that the length of time with rheumatoid arthritis did not seem to have an effect on risk for developing heart disease.

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In rheumatoid arthritis (RA), joints in the body (often in the hands and feet) become inflamed, causing pain, stiffness and problems with motion.

According to the American College of Rheumatology (ACR), "Research shows that people with RA, mainly those whose disease is not well controlled, have a higher risk for heart disease and stroke."

This new study, led by Elke E.A. Arts, MSc, of the Department of Rheumatology at Radboud University Medical Centre in Nijmegen, The Netherlands, aimed to explore if the disease duration (the length of time a patient has had RA) and disease activity (the intensity and spread spread of RA) were associated with the risk of heart disease.

Arts and colleagues identified 855 RA patients who were recruited from clinics in Nijmegen starting in the mid 1980s. These patients did not have a history of heart disease at the study's start, when their average age was 54.

The patients were followed for at least six months, and when the study began, they had a disease duration of under a year.

The researchers used the 28 joint disease activity score (DAS28) to measure disease activity. This score looks at tenderness and swelling in 28 commonly affected joints alongside results from blood tests looking for signs of inflammation.

According to the National Rheumatoid Arthritis Society, a DAS28 higher than 5.1 represents active disease, a score lower than 3.2 represents "well controlled" disease and a score lower than 2.6 represents RA remission. The average DAS28 score for the patients in this study was 3.6.

Arts and colleagues used medical charts and electronic patient files to identify cardiovascular events, including stroke, peripheral artery disease, acute coronary syndrome and bypass surgery, among others.

During the follow-up period, which accounted for 9,959 patient-years, 154 such cardiovascular events were reported, 16 of which resulted in the patient's death. At the time of analysis, patients had an average disease duration of 11.7 years.

The disease duration did not seem to have a significant effect on the risk of heart disease. The patients who had a disease duration of less than 10 years and patients who had a disease duration of over 10 years had no major difference in their risk of cardiovascular events.

The researchers did see some differences in cardiovascular events between those with low DAS28 scores (under 3.2), moderate scores (3.2 to 5.1) and high scores (over 5.1), but after adjusting for potentially interfering factors (like other health issues, age and weight), there was not a significant increase in heart disease risk for those with a high DAS28 score compared to those with a low score.

"Disease duration does not appear to independently affect the risk of [cardiovascular disease]," wrote Arts and colleagues. "The risk of [cardiovascular disease] in RA patients was not increased after 10 years of disease duration compared with the first 10 years."

However, the study's authors did note that disease activity over time could contribute to heart disease risk, but further research into this topic is needed.

This study was published online January 23 in the Annals of the Rheumatic Diseases.

Arts reported receiving funding from the Rheumatology Research University Nijmegen foundation, and another study author reported receiving grants for travel and fees for serving on the advisory board of several pharmaceutical companies, including Abbott and Pfizer.

Review Date: 
January 23, 2014
Last Updated:
January 26, 2014