How Arthritis Medications Can Affect Your Heart 

Reviewed March 29, 2022

Medications used to treat arthritis, especially inflammatory forms of arthritis, like rheumatoid arthritis, typically aim to reduce the excess inflammation underlying the disease. Because inflammation is also a trigger for cardiovascular disease (CVD) in some people, the medications used for arthritis may also impact CVD risk. While some arthritis medications may reduce CVD risk, others seem to have an opposite effect on the cardiovascular system, increasing risks. Following are some of the most noteworthy arthritis medications that may raise CVD risks.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, are some of the most common drugs used to treat arthritis pain, and they are widely available over the counter as well as by prescription. Yet NSAIDs can be harmful to the heart. Back in 2005, the Food and Drug Administration (FDA) added a label to these drugs warning that they increase the chance of a heart attack or stroke.  

In 2018, based on more recent research, the agency strengthened its warning, adding that NSAIDs can contribute to a heart attack or stroke within the first few weeks of use, and that the risk increases with longer use and higher doses. The odds of a cardiovascular event (e.g., heart attack or stroke) are highest in people with pre-existing heart disease, but even those with no history of a heart problem could be vulnerable. 

“The reason that NSAIDs and COX-2 inhibitors [like celecoxib, or Celebrex] raise risk is not entirely clear,” says rheumatologist Daniel H. Solomon, MD, professor of medicine at Harvard Medical School. “They appear to limit the body’s ability to keep blood vessels open, raising blood pressure in some people, and also possibly affecting the body’s clotting system. But they also have beneficial effects on pain.”  

When deciding whether to use NSAIDs, balance your need for pain relief with the potential side effects. If you do take these drugs, use the lowest possible dose for the shortest period of time needed to control your pain. And be aware that many common medicines, including cold and cough medicines, contain NSAIDs, so it can be easy to take too much without knowing it.

Tocilizumab (Actemra)

This biologic drug is FDA-approved to treat people with moderate to severe rheumatoid arthritis (RA) that hasn’t improved after they’ve tried at least one DMARD. It is also approved to treat giant cell arteritis, as well as systemic or polyarticular juvenile idiopathic arthritis in patients age 2 or older. The FDA granted emergency use authorization for it to be used to treat COVID-19 in certain hospitalized adults and children.  

RA itself raises the risk of cardiovascular diseases (CVD), and tocilizumab raises cholesterol levels, a risk for heart disease. This has led to cautious use of the drug in people at risk of CVD; however, more recent studies have found that the risk is no greater with tocilizumab than with certain other medications, including tumor necrosis factor (TNF) inhibitor biologics. 

If your doctor recommends this drug, ask whether you should be monitored for heart problems more closely while you’re on it. 

Prednisone

Prednisone is a corticosteroid (steroid) drug that treats RA by reining in inflammation. Yet it can be damaging to the heart by raising blood pressure, increasing cholesterol levels.  

Prednisone also contributes to weight gain, and in some people raises blood sugar; both factors can independently increase heart disease risk. Epidemiologic studies find that corticosteroids make people more vulnerable to having a heart attack, stroke, heart failure and other major heart events. 

You always want to take the lowest dose of corticosteroids possible, Dr. Solomon says. “Steroids can quickly and effectively reduce inflammation and pain in people with inflammatory arthritis. But the goal is to balance the potential benefit on pain and function with its many potential deleterious effects.”

Tofacitinib

In 2021, the FDA strengthened warnings about using tofacitinib (Xeljanz, Xeljanz XR) after post-marketing studies showed it increases the risk of serious heart-related problems, like heart attack and stroke, as well as infection and blood clots. These studies were conducted in people with risk factors for CVD events.

Tofacitinib works by interfering with an enzyme called Janus kinase (JAK), which has a role in creating too much inflammation by the immune system. It is one of the growing number of “JAK inhibitors” used to treat inflammatory arthritis, in addition to baricitinib (Olumiant) and upadacitinib (Rinvoq). Because they all work in the same way, with similar benefits and risks, the FDA broadened the warning to include all three drugs.

Caring for Your Heart While Treating Arthritis

When you live with arthritis, it’s important to balance the need for arthritis relief with the potential risks of the drugs that treat it. The silver lining may be that caring for both your heart and your arthritis will keep you eating well, exercising and tobacco-free, which will help you stay healthier overall.