Rheumatoid Arthritis and Type 2 Diabetes at High Risk for Cardiovascular Disease!!!

Rheumatoid arthritis (RA) is an autoimmune disease that causes a chronic inflammation in the synovial membranes of multiple joints in the body. It attacks the lining of the joints and often produces severe pain and inflammation, joint disfigurement, and loss of joint movement and function. Extra-articular involvement including rheumatoid nodules, vasculitis, eye inflammation, neurologic dysfunction, cardiopulmonary disease, lymphadenopathy, and splenomegaly are manifestations of the disease. Although the usual disease course is chronic, some patients will spontaneously enter a remission.

Cardiovascular disease or heart disease is a class of diseases that involve the heart or blood vessels (arteries and veins). There are several risk factors for cardiovascular disease that are essentially immutable. These are older age, male gender, and a family history of CVD. Additionally, three major risk factors identified include cigarette smoking, dyslipidemia (high cholesterol), and hypertension. Other identified factors associated with increased risk for cardiovascular disease include physical inactivity, sleep problems, diabetes mellitus, rheumatoid arthritis, obesity, excessive intake of alcohol, thrombotic and fibrinolytic factors, elevated homocysteine levels, certain infections and inflammation, exogenously administered estrogens and androgens, certain psychosocial factors, increased fasting glucose. and frequency of migraines. The synergism of the presence of multiple risk factors must also be considered.

A recent study sought to compare the incidence of cardiovascular disease in patients with rheumatoid arthritis with the incidence of type 2 diabetes. The cohort study included 353 patients with rheumatoid arthritis who were followed for three years to determine the incidence of cardiovascular disease. The researchers then used Cox proportional hazard models to compare this incidence with the three-year incidence of cardiovascular disease in a general population cohort consisting of 1852 people, of which 155 had type 2 diabetes. It was found that the three-year incidence of cardiovascular disease was 9 percent in patients with RA and 4.3 percent in the general population. The results revealed that both patients with RA and patients with type 2 diabetes had two times the risk of cardiovascular disease compared with the general population. Therefore it appears that RA and type 2 diabetes have an equally strong risk factor for developing cardiovascular disease.1

1 Peters MJ, van Halm VP, Voskulyl AE, et al. Rheumatoid arthritis: an equally strong risk factor for cardiovascular disease as diabetes mellitus. Ned Tijdschr Geneeskd. 2010;154(17):1469.