It’s been known for some time that an increased risk of cardiovascular disease often accompanies both rheumatoid arthritis (RA) and spondyloarthritis (a type of arthritis that primarily affects the spine). A new study, however, has found this risk is present even in the early stages of the two diseases.
The research was conducted at Leiden University Medical Center in the Netherlands. A team of investigators analyzed data collected from arthritis patients in France; 689 patients had early rheumatoid arthritis (ERA), and 645 had early axial spondyloarthritis (ESpA). For the ERA patients, the diagnosis of disease was made within the previous six months; for the ESpA patients, it was three years.
The study looked for what physicians call “comorbidities,” diseases or conditions that occur along with a primary disease. For example, because many people with diabetes also have high blood pressure, high blood pressure is considered a comorbidity of diabetes. The study discovered that 42.7% of the ERA patients had at least one comorbidity; among the ESpA patients, the proportion was 20.3%.
The most common comorbidity among ERA patients was high blood pressure; the others, in order, were high cholesterol levels, impaired thyroid function, tuberculosis and malignancies. The most common comorbidity among ESpA patients was high cholesterol, followed by high blood pressure and ulcers.
All these comorbidities, however, are common in the general population, but certain ones appeared more in the arthritis patients than in the population as a whole. The incidence of high blood pressure, for example, was significantly higher among the ERA population than in the general French population.
The researchers also discovered age and sex differences. The risk of cardiovascular disease in women ages 40 to 65 generally is low, but not so among female early arthritis patients in that age group. In general, the researchers determined ERA patients had a notably higher risk of cardiovascular disease. Among men over 55, the risk of developing cardiovascular disease within 10 years was more than 20%, which is considered high risk. In women over 60, the risk was between 10% and 20%, considered an intermediate risk. Finally, the researchers looked at what is called “heart age”—a comparison of how “old” a person’s heart is compared to the person’s actual age. They found that, in general, patients with ERA had heart ages between four and 10 years older than their chronological ages.
Finally, the incidence of tuberculosis also was found to be higher in both the ERA and the ESpA patients than in the general population. The researchers were unable to explain exactly why there is a connection between arthritis and tuberculosis, but they pointed to earlier studies on mice that suggested tuberculosis can enhance arthritis.
The study has obvious important implications. In the past, physicians might not immediately have considered screening newly diagnosed arthritis patients for cardiovascular problems. In the light of this new research, they might want to reconsider. Also, patients themselves might want to inquire about their possible elevated risk.