Arthritis and Heart Disease

By Linda Rath | Updated Dec. 26, 2022

Arthritis might be a joint disease, but the effects don’t stop there. Inflammatory forms of arthritis like rheumatoid arthritis (RA), psoriatic arthritis (PsA), gout and lupus also put you at increased risk of heart disease. That includes heart attack, stroke, atrial fibrillation and heart failure. It’s estimated that people who have RA are twice as likely to have a heart attack compared to those who don’t. Gout, the most common type of inflammatory arthritis, is associated with abnormal heart rhythms, or atrial fibrillation (A-fib), which causes about one in seven strokes. And an older review and meta-analysis of studies involving more than 30,000 patients found that heart disease was 43% more likely to develop in people with PsA than the general population.

Chronic Inflammation and Your Heart

People with rheumatic conditions are more likely to have traditional heart disease risk factors such as high LDL (“bad” cholesterol), obesity and type 2 diabetes. But the most important shared risk factor by far is chronic inflammation. 

“Inflammation, regardless of where it comes from, is a risk factor for heart disease,” says rheumatologist Jon T. Giles, MD, assistant professor of medicine at Columbia University School of Medicine. “So it’s not surprising that people with inflammatory arthritis like RA, lupus and psoriatic arthritis have more cardiac events.”

Inflammatory cells get into blood vessel walls where they make cytokines — immune system proteins that promote inflammation. Inflammation also reshapes blood-vessel walls, making deposited plaques more prone to rupture. A rupture, in turn, can trigger a heart attack.

In gout, uric acid is also at play. Uric acid is produced from the breakdown of purines — substances found naturally in your body and in food. Gout occurs when excess uric acid forms sharp crystals around joints. Uric acid also makes heart disease more likely. A study that analyzed Medicare data from more than 1.6 million people over age 65 found that gout doubled the risk of A-fib in older adults. It’s assumed that inflammation is the link between uric acid and heart disease, even in people who don’t have gout.

Heart risk isn’t limited to people with inflammatory arthritis. Although osteoarthritis (OA) isn’t in itself highly inflammatory, its damage can cause inflammation, which in turn increases the risk of heart disease. Shared heart disease risk factors such as high cholesterol and diabetes, along with inactivity and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) also increase the risk. 

Medications and Heart Risk

The best advice is to work with your rheumatologist to get arthritis under control and ensure you have the lowest amount of systemic inflammation possible. For many people, this includes taking medications. The problem is that while arthritis drugs can help ease joint symptoms, some are also hard on the heart. Here’s what you should know: 

• JAK inhibitors. Tofacitinib (Xeljanz) increases the risk of heart attack, stroke, serious blood clots and death. It along with two other JAK inhibitor drugs — baricitinib (Olumiant) and upadacitinib (Rinvoq) — carry the strongest warning from the Food and Drug Administration (FDA). If you take one of these drugs, talk to your doctor about switching or ask for a different medication to start with, especially if you have heart disease risk factors.
• Disease-modifying antirheumatic drugs (DMARDs). Methotrexate and other conventional synthetic DMARDs are the most commonly prescribed medicines for RA, PsA and some other forms of inflammatory arthritis. An analysis of 14 trials based on claims and national databases such as Medicare, Medicaid and the VA found that these drugs carry a greater risk of heart attack and stroke compared to tumor necrosis factor (TNF) blocker biologics, like adalimumab (Humira) and etanercept (Enbrel). Researchers suspect this may be because patients taking TNF blockers have better controlled inflammation and use fewer corticosteroids and nonsteroidal anti-inflammatory drugs.  
• Nonsteroidal anti-inflammatory drugs (NSAIDs) also increase the risk of heart attack and stroke. In 2018, the FDA cautioned they can lead to life -threatening heart events within just a few weeks of use. The risk increases with longer use and higher doses. If you do take an NSAID, use the smallest possible amount for the shortest period of time needed to manage your symptoms.
• Corticosteroids, like prednisone. Though prednisone lowers inflammation, it can also raise blood pressure, increase cholesterol levels and harden the arteries, in addition to having a number of other serious side effects. To protect your heart, vision, bones and overall health, try to avoid corticosteroids as much as possible. 

At least one arthritis drug may be heart protective. Colchicine is an inexpensive and generally safe anti-inflammatory used for years to treat gout. It’s now also prescribed for some people as a preventive after a heart attack or other cardiac event. In large studies, low-dose colchicine cut the likelihood of a second life-threatening heart problem by 30%.

Lifestyle and Your Heart

Having arthritis and taking arthritis medications doesn’t make it inevitable that you’ll develop heart disease. But your risk goes up with obesity, high blood pressure, diabetes, high cholesterol and smoking. And you can take measures to lower the risk through some lifestyle changes. 

The best place to start? A dose of daily exercise and an anti-inflammatory eating plan like the Mediterranean diet.

Many studies have shown that people who exercise are less likely to have a heart attack or other serious heart problem. Hundreds of studies have also shown that exercise can significantly reduce inflammation, relieve arthritis pain and improve mobility. It’s the one treatment that gets the strongest recommendation from the American College of Rheumatology (ACR).

Studies further show that people with arthritis can and should do the same amount and types of exercise as people who don’t have arthritis. The American Heart Association recommends 30 minutes of aerobic exercise most days and resistance or weight training a few times a week. Swimming is a good option because the water helps support your joints, but a pool might not be accessible. What’s important is finding a sport or activity you enjoy and can stick with for the long haul. The same consistency in following a healthy eating plan is also key.

Quick Facts

• People with RA have a 50% to 70% higher risk for cardiovascular disease than the general population.
• People with OA face a 24% higher risk for cardiovascular disease than the general population.
• Nearly half of all adults with heart disease also have arthritis.