Rheutoid arthritis linked to heart disease

WASHINGTON, Jun 28, 2005 (United Press International via COMTEX) -- Rheumatoid-arthritis sufferers are at an increased risk of death if they also suffer from coronary artery disease, U.S. researchers have found.

In a report to be published in the June 29 issue of the journal Arthritis Research and Therapy, the researchers said patients who suffer from rheumatoid arthritis in combination with multi-vessel coronary artery disease show an increased risk of death from heart disease compared to those who do not have both conditions.

Dr. Cornelia Weyand, a rheumatologist at the Mayo Clinic in Rochester, Minn., said she thinks the implications go beyond those diagnosed with rheumatoid arthritis.

"Studying how the rheumatoid process affects heart attacks ... can trail down to you and me," Weyand told United Press International. "The process of this is very important for almost everyone."

The research, based on analysis of medical records obtained through the clinic, compared patients who had sought treatment from 1985 to 1998 in Olmsted County, Minn., and who were diagnosed with coronary artery disease with patients who had rheumatoid arthritis in combination with coronary heart disease.

The research was case-controlled, Weyand explained, meaning patients with CAD were matched closely with patients of similar characteristics with both RA and CAD. The data suggested a higher rate of cardiovascular problems in patients with both CAD and RA.

Weyand and colleagues then collected blood samples from 27 of the patients. The results showed a higher prevalence of CD4 CD28 null T-cells, a condition known to cause an inflammation of body tissues -- in this case, coronary arteries.

Dr. Mark Gostine, founder of Michigan Pain Consultants in Grand Rapids, who specializes in treating immune system disorders, told UPI inflammation of the arteries in combination with high levels of cholesterol are precursors to cardiovascular problems such as atherosclerosis, the buildup of fats along the artery walls. Inflammation of the arteries allows increased space for buildup, which in turn leads to coronary artery disease and a highly increased risk of heart disease.

"For years it was thought heart disease was linked solely to high cholesterol," Gostine told UPI. "Recent studies have shown now that levels of inflammation are a huge factor."

Dr. Robert Lahita, professor of medicine at the Mount Sinai School of Medicine in New York City and fellow of the American College of Rheumatology, told UPI the possibility that rheumatoid arthritis has been linked to higher rates of cardiovascular problems is nothing new.

"We (Mount Sinai) knew about this five years ago," Lahita told UPI. "In these patients (who have rheumatoid arthritis), it would seem theoretically natural to see these (T-cells) attack vessels of the body. ... Now we have hard data to back this up."

Lahita noted that many anti-inflammatory drugs, such as Vioxx and Celebrex, reduce inflammation not only in arthritic joints, but also in arterial tissue. This causes the buildup to compress, restricting blood flow and increasing the risk of heart attacks and accelerated coronary artery disease.

Rheumatoid arthritis is an autoimmune disease that affects about 2.1 million Americans, or about 1 percent of the population, according the National Institutes of Health in Bethesda, Md. It is similar to arthritis, because it involves joint inflammation, but the inflammation tends to be symmetrical -- meaning, for example, if one hand is affected, the other will be as well.

Rheumatoid arthritis is part of a wide range of autoimmune disorders, such as lupus and multiple sclerosis, in which the immune system attacks the body instead of protecting it.

Lahita, who recently authored "Women and Autoimmune Diseases: The Mystery Ways Your Body Betrays Itself," said the link between RA and CAD and its implications for people of young ages is staggering.

"What you're seeing ... is young people (with autoimmune disorders) getting coronary artery disease at younger ages," he said. "You see it in young women with lupus, you see it in young people with rheumatoid arthritis."

Weyand said research currently being conducted at Emory University -- with which she is affiliated -- is focusing on how the T-cells are causing coronary artery inflammation in rheumatoid arthritis, which could be the key to a treatment.

"In order to stop these disorders," she said, "we need to understand how inflammation is regulated (by the immune system)."

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Ray Pregeant is an intern for UPI Science News. E-mail: sciencemail@upi.com