11/9/10 A new study presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta might help explain why people with rheumatoid arthritis, or RA, tend to have more heart attacks and strokes than the general population. Researchers found that inflammation, a signature of this autoimmune disease, may be contributing to the build-up of plaque in arteries. They also found that certain arthritis drugs might play a role in RA patients’ risk of heart disease.
“One key finding of our study was that RA patients had to have both high levels of inflammation and higher numbers of traditional cardiovascular risk factors, like high blood pressure, diabetes, etc., in order for inflammation to be a risk factor for carotid plaque progression,” explains lead investigator Jon T. Giles, MD, an assistant professor of medicine in the division of rheumatology at Johns Hopkins University in Baltimore.
For this study, researchers gave 158 RA patients two ultrasounds three years apart to assess the thickness of their carotid artery walls.(Two common carotid arteries, one on each side of the neck, branch off into smaller internal and external arteries that deliver blood to the brain and face.) In doing so, they discovered that 82 percent had a thickening of their common carotid artery walls and 70 percent had a thickening in their internal carotid artery walls.
They also found that this risk was reduced with some RA drugs and increased with others. Those on anti-TNF biologic medications at the start of the study had 37 percent less thickening than those not on the drugs. Examples of anti-TNF medications used to treat RA include certolizumab, or Cimzia, etanercept or Enbrel, adalimumab, or Humira, infliximab, or Remicade, golimumab, or Simponi. Prednisone, a corticosteroid, caused more thickness, but that effect was tempered when patients were also given statins to lower cholesterol.
“The good news is we’re just trying to get a handle on the long-term use of TNF blockers: Are they good or bad, aside from the fact that they improve the arthritis symptoms,” says Robert Katz, MD, a rheumatologist at Rush University Medical Center in Chicago and a professor of medicine at Rush Medical College. “It is reassuring to those who want to take those drugs, judging by this study, that it might actually reduce risk for heart attack or stroke.”
He adds, “If you are on prednisone, you should watch your blood pressure, glucose and cholesterol even more closely.”
Researchers also report that plaque build-up, also called atherosclerosis, was higher in patients with the highest number of swollen joints and those with elevated levels of c-reactive protein. C-reactive protein is a marker of inflammation in the body.
Doctors say these findings indicate that reducing inflammation in RA patients could potentially reduce the number of cardiac problems these folks have, but Dr. Giles says future research needs to specifically test these medications to compare their effects on plaque build-up.
“Our study was not interventional, so any conclusions applied to clinical care are only extrapolations,” he says. “However, our data suggest that reducing inflammation, particularly in patients with traditional cardiovascular risk factors, may help reduce the build-up of atherosclerosis that leads to heart attacks and strokes.”
Wow! It sounds like you have a lot of difficult things bearing down on you at present. It may seem impossible, but when I'm in similar circumstances, I practice slow, focused breathing which helps me have better mental focus for solving my problems.
You might also seek assistance from various organizations in your community. Are there any free clinics in your area? Have you applied for assistance from your county's Dept. of Social Services? Do you have friends who are good at using the internet? If so, ask your friends to find out if any of them will help you find possible sources of the medications you need. Some compassionate doctors distribute samples to their patients who don't have the money to buy the meds from a pharmacy. Good luck. You're stronger than you know!
She had severe RA and took high levels of prednisone, percoset and had just begun rituxin infusions. She was a chain smoker, had 3 hip replacement surgeries and was scheduled for knee surgery this week.
She died quickly and through the night. She had shown no symptoms of high BP or heart disease. It was only that day that she had been complaining of middle back pain.
There were days were she could not get out of bed, her hands were badly disfigured and yet she continued to smile each day. She would be in the hospital at least every two months due to a bacterial infection that would cause her body to swell badly and the only way to treat the infection was through IV antibiotics.
Our mother and aunt both died of complications from this debilitating disease and my other sister and I both suffer from RA. I am fortunate to have a very active Primary physician, Pain management doctor and Rheumatologist that are a team.
I have a leaky heart valve due to the medicines for the RA and am monitored very closely.
Both of my sisters are on disability and don't have the luxury of the insurance benefits that I am so blessed to have.
My sister and I are scared. From our view of this disease and the results that have occurred, we take each day as a blessing.
Please, make sure to have all the required blood work, and communicate with your doctors. My sister did not.
Tengo 74 años, soy portador de una arritmia cardiaca de 20 años de evolucion, controlada con medicamentos:digoxina y amiodarona y otros, sin problemas colaterales. Ademas tengo psoriasis palmo-plantar de 40 años de evolucion tratada con drogas como el metotrexato y otros corticoides como la prednisona que normaliza el problema de mi piel.Ademas tengo artrosis de ambas caderas, en la region lumbosacra y columna cervico dorsal, tratada esta última con un antiartrosico de Glucosamina sulfato KCL y condroitina sulfato.
Existe alguna relación o riesgo de problemas cardiacos que pueda tener con el consumo especialmente de prednisona en el tratamiento de mi psoriasis?
I noticed the post on cholesterol lowing drugs. I was told I had very high cholesterol last spring, started taking Crestor & w/in 1 month, had to be rushed to the emergency room suffering w/severe muscle spasms in my neck. They diagnosed this at the time as being torticollis treated me w/muscle relaxers & morphine! I have never experienced something so extreme for no apparent reason.
In casual conversation during this ordeal, a physicians assistant told me of her Mother having being diagnosed w/this torticollis & explaining how much it wrecked her life. I could not believe what I was hearing as it seemed almost identical to my experience. I'm pretty certain the cholesterol lowing RX caused this to happen to me. I quit the medication, changed my diet, started taking CoQ10 along with Omega Fish Oil & have lowered my cholesterol. I hope this same thing never happens to anyone else.
Desde 20 anos yo estoy con Prednisone , por mi RA yo trate muchos medicamentos desde Gold inyecciones, Metrotaxate, Celebrex, Arava , Embrel, Humira la que me causo hace un ano Tubercolosis, a pesar de estar en costante chequeo medico, estuve 6 semanas hospitalizada y otros 2 meses en casa, termine ese mi tratamiento en 6 meses, ahora mi tratamiento para mi Ra es Plaquenil, azulfadine, Predniosone 7.5 diario, Mynocicline mas otras para el estomago , lo ultimo es que tengo Osteoporosis y necesitare a Hip remplacement pero ahora al leer todas las opiniones estoy muy preocupada por mas complicaciones
Does anyone have a good sugustion? PS I have been on Celebrex, it only helps the hip but doesn't seem to help anywhere else. I would like to state that I am no onger going through anymore epidorals or cordizone shots which are one a bandade on a large and growing problem.
My Insurance co-pay for enbrel was not financially possible and I am scared to death I will suffer another heart attack. I am currently having test run to see if I am also diabetic so the fear is greater. Any suggestions on what I can do?
Scientists from the UK and Australia looked at how death and heart attack rates changed with more intense statins - taken by several million people each year.
The results, published in medical journal The Lancet, found that stronger treatments cut the numbers of major heart attacks and strokes by a "highly significant" 15%.
This included a 13% cut in heart-related death or non-fatal heart attacks, a 19% cut in patients needing bypass and other coronary treatments, and a 16% drop in strokes, the study said.
Nearly 40,000 high-risk patients were part of the research, which measured effects after one year of taking either regular or intensive treatment statin treatment to combat so-called "bad" LDL cholesterol.
Lead researcher Colin Baigent, of Oxford University, said: "It is a continuous relationship right the way down to very low levels of LDL cholesterol."
Statins - among the world's biggest-selling drugs - work by blocking the action of a certain enzyme in the liver which is needed to make cholesterol.
The research found no significant effects on deaths due to cancer or other non-vascular causes.
But it warned that simply raising the dose of the most commonly-used statin in the UK, simvastatin, might lead to some health problems. A rare side-effect of simvastatin is muscle weakness, known as myopathy, and in some cases it can lead to more serious muscle damage.
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