“The reason that NSAIDs and COX-2 inhibitors raise risk is not entirely clear,” says Dr. Solomon. “They appear to have a deleterious effect on the body’s ability to keep its blood vessels open, and that raises blood pressure. But they also have beneficial effects on pain. Again, you need to balance the potential benefits and the risks.”

Other common arthritis medications offer heart-protective benefits, including these: 

  • Tumor necrosis factor-alpha inhibitors. A 2011 study published in the Annals of Rheumatic Diseases found that patients who took these drugs, commonly called anti-TNF drugs,such as etanercept (Enbrel), infliximab (Remicade) or adalimumab (Humira), had a reduced risk of heart disease. They block inflammation-inducing cytokines involved not only in RA, but also in psoriatic arthritis and ankylosing spondylitis. The Johns Hopkins study that found inflammation plus other heart disease factors are at work in raising RA patients’ heart risks also found that those taking TNF inhibitors had a 37 percent lower rate of thickening in their carotid arteries than those not taking it, says Dr. Giles. Thickened arteries signal early atherosclerosis.

     However, a study published in the American Heart Journal found that, in elderly patients with RA, TNF inhibitors raised the risk of heart failure. The effect of TNF inhibitors is clearly different on the heart muscles than it is on the arteries, says Dr. Giles. 

  • Methotrexate. This disease-modifying antirheumatic drug, DMARD, is often the first drug given to people with RA. A 2010 British review of 18 studies, published in Rheumatology, found that people with RA taking methotrexate lowered their heart disease risk. “A large amount of research shows that methotrexate can reduce the risk of heart disease,” says Dr. Solomon, possibly by reducing the build-up of plaque in the arteries.
  • Hydroxychloroquine (Plaquenil). A 2011 British review published in Current Opinions in Lipidology found that hydroxychloroquine, an antimalarial drug used to treat RA and lupus, improved heart disease risk factors such as blood sugar and cholesterol levels – though Dr. Solomon notes that the drug is not directly associated with a reduced risk of heart disease.

It may seem terribly unjust when you have arthritis to be forced also to worry about your heart. But the silver-lining insight may be that caring for both your heart and your arthritis will keep you eating well, exercising and smoke-free, which will keep you healthy in many other ways.