It’s a vicious cycle: You’re in pain, so you don’t exercise, and not exercising means your joints hurt more. That can lead to a sedentary lifestyle that increases your heart disease risk. You can take control of lifestyle factors by starting slowly and sticking with it. Try a few simple dietary changes: for instance, swap one daily sugar-sweetened beverage for a glass of water, fried chicken for grilled chicken or a cupcake for a handful of heart-healthy nuts.

The U.S. Department of Health and Human Services’ 2008 Physical Activity Guidelines for Americans recommend that everyone, including those with arthritis, get 150 minutes of moderate exercise per week. That's 30 minutes a day, five days a week. But if you’re in constant pain or just inactive, the key is to just get moving. Start with a walk down the street and back every day, if that’s all you can handle – and build up gradually. Your joints will feel better and your heart will be healthier. According to the University of Maryland Medical Center, people who are active have a 45 percent lower risk of heart disease than do couch potatoes and a 35 percent lower risk of high blood pressure. 

Medications. Most ironic is that some of the very medications that help control arthritis can raise heart disease risk. On the flip side, some reduce risk. Here’s a breakdown of what the research shows so far.

Those that may harm the heart:

  • Tocilizumab (Actemra). Approved by the FDA in January 2010, this drug for RA remains under scrutiny. “The FDA has required the makers to study its cardiovascular safety,” says rheumatologist Daniel H. Solomon, MD, associate professor of medicine at Harvard Medical School. The drug raises cholesterol levels, he adds, so anyone taking it should have her cholesterol monitored, and, if it is high, take statin medications.
  • Prednisone This corticosteroid commonly used to control inflammation may oddly enough may raise heart disease risk. A 2011 study published in the Annals of Rheumatic Diseases found that risk of cardiovascular events or death rose as the prednisone dose rose. “Prednisone can cause a worsening of blood pressure,” says Dr. Grayson. “You retain fluids with steroids and gain weight, which can increase heart disease risk even when you’re lowering inflammation.” You always want to try to be on as low a dose of steroids as possible, says Dr. Solomon. “Obviously, steroids have an incredible effect at reducing inflammation. So the goal is to balance the potential benefit on pain and function with the deleterious effects on the heart.”
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). It’s not news that these drugs can affect the heart, and the evidence keeps mounting. A 2011 Swiss review of 31 trials published in the journal BMJ found that COX-2 inhibitors and traditional NSAIDs, except for naproxen (Aleve), raised the incidence of heart attack, stroke or heart-related deaths by two to four times. Danish researchers reported in Circulation, Cardiovascular Quality and Outcomes that diclofenac had the highest threat, increasing the relative risk of a fatal heart attack or stroke by 91 percent. 

     Even short-term NSAID use appears to be a problem. A 2011 study published in Circulation found that NSAIDs taken for up to seven days raised the risk of heart attack by 45 percent in patients who had already had one attack. After three months, the risk increased to 55 percent, Copenhagen University Hospital researchers found.

NSAIDs, including the COX-2 inhibitor celecoxib (Celebrex) also can raise the risk of atrial fibrillation, according to a 2011 Danish study published in BMJ.