The risk of heart attack and stroke is increased for women with rheumatoid arthritis and psoriasis, and for men with psoriasis
Arthritis is the leading cause of pain and disability. The disorder typically causes pain and inflammation in the joints, and can affect people of all ages. It is an extremely debilitating condition that can force people to give up work or favourite hobbies.
There are several kinds of arthritis, including the commonly known osteoarthritis. This type is related to wear and tear of the joints due to older age, or damage from sports and other activities. But other kinds of arthritis – known as inflammatory arthritis – can affect the organs and skin, too.
In our newly published research, we wanted to find out the associated cardiovascular risks that come with types of inflammatory arthritis – particularly rheumatoid arthritis and psoriatic arthritis. Researchers have found that people with rheumatoid arthritis (which occurs when the body’s immune system targets affected joints, leading to swelling and pain) have higher rates of cardiovascular disease. And those with rheumatoid and psoriatic arthritis also have an increased risk of developing other conditions, such as skin and heart disorders.
However, it is not entirely clear whether those with psoriatic arthritis – a joint condition that affects around 30% of people with the skin condition psoriasis – are subject to a higher risk of cardiovascular disease, too.
We cannot simply say arthritis causes heart problems, as there are numerous factors at play. There are several things that can affect everyone’s heart health whether they have inflammatory arthritis or not. Obesity and smoking are just two examples. However, as the disease process of rheumatoid and psoriatic arthritis involves inflammation, this can cause an additional risk of developing heart problems. Add to this that treatments used to control arthritis symptoms can also affect cardiovascular health and the situation becomes even more complex to understand.
So, to understand the true cardiovascular risk in individuals with inflammatory arthritis, we decided to look at the health records of patients with rheumatoid arthritis, psoriatic arthritis and psoriasis.
Using information from an anonymised databank, we looked at GP, hospital and death records of arthritis and psoriasis patients in the UK. 8,650 had been diagnosed with rheumatoid arthritis, 2,128 with psoriatic arthritis, and 24,630 with psoriasis. We then compared these to 1,187,706 individuals without these conditions, looking at rates of heart attack, stroke and deaths related to these.
When the data was analysed, we found that cardiovascular risk factors were higher for those who had rheumatoid arthritis, psoriatic arthritis, and psoriasis, compared to people who did not have these conditions.
When we controlled for known cardiovascular risk factors (such as obesity and high blood pressure) there was still a higher risk of heart attack and stroke in women with rheumatoid arthritis, and in men and women with psoriasis. This increased risk of heart attack and stroke can be explained by the inflammation in rheumatoid arthritis causing inflammation in the heart. However, we are not yet sure why this occurs only in women. In addition, we know the level of inflammation in psoriasis is low so this does not explain the higher risk of heart attack and stroke in this group.
Though we have found evidence of increased risks, more medical research will need to be done to work out what the best cause of action is for those with inflammatory arthritis. In the meantime, people with inflammatory arthritis and psoriasis should be closely monitored and given extra support to help prevent heart attack and strokes.
Research Fellow, National Centre for Population
Health & Well-being Research
* Published in print edition on 1 May 2018