Arthritis Related Heart Problems

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Arthritis Related Heart Problems: A Disease-by-Disease Look

Although atherosclerosis is the most common cardiovascular problem in people with arthritis, particularly those with rheumatoid arthritis (RA) and lupus, it is far from being the only one. Different forms of arthritis can affect the heart in many ways. Here are some examples.

Rheumatoid arthritis: Most people with RA have some pericarditis, or inflammation of the lining of the heart. For the majority, the problem causes no symptoms, but for some, pericarditis is signaled by chest pain. In its early stages, pericarditis responds well to glucocorticoid medications to ease the inflammation. In rare cases, however, the pericardium thickens and constricts the function of the heart. Surgery to remove the pericardium, in these cases, generally restores heart function.

Lyme disease: As many as 5 percent to 10 percent of people infected with B. burgdorferi, the agent that causes Lyme disease, will develop heart problems if not promptly treated with antibiotics to eradicate the infection. Problems can range from mild inflammation of the heart muscle itself to heart block, a condition in which the electrical impulses that cause the heart to beat are slowed down, interfering with the heart's ability to pump blood. In rare cases, such problems can become chronic. In most people, however, Lyme-related heart problems respond to antibiotic therapy or even resolve on their own.

Ankylosing spondylitis: In people with ankylosing spondylitis (AS), particularly those with joint involvement beyond the spine, inflammation in different parts of the heart can cause a number of problems, including heart block (as with Lyme disease, above) and damage to the valves, which regulate the flow of blood through the heart. Unlike heart block associated with Lyme disease, heart block with AS is usually irreversible. In severe cases, it may cause temporary lapses of consciousness as blood flow ceases and requires the placement of a battery-operated pacemaker. Severe valve damage may require replacing the damaged valve(s) with synthetic or donor valves.

Kawasaki disease: An inflammatory disease that affects primarily young children and which is most common in Japan, Kawasaki disease is associated with numerous cardiovascular problems. Approximately one-half of children with the disease have myocarditis (inflammation of the heart muscle) and a fourth have pericarditis (see RA above). Other related problems that occur in Kawasaki disease include inflammation of the heart valves and coronary arteries and aneurysms (balloon-like swellings in the walls of the arteries).

Lupus: A number of heart-related problems can occur in people with systemic lupus erythematosus. Like RA, lupus is often accompanied by pericarditis. It is also associated with a problem called Libman-Sacks endocarditis, an inflammation of the heart manifested by accumulations, called vegetations, of immune complexes, inflammatory cells, clotted blood and other debris. These vegetations often occur on the mitral valve, the flap of tissue that allows blood to pass from the heart's atrium to the ventricle.

Another cardiovascular risk with lupus occurs in people with antiphospholipid antibodies. An estimated one-third of people with lupus have these autoantibodies, which predispose to blood clotting, increasing the risk of heart attack or stroke. Treatment for antiphospholipid antibodies can include daily baby aspirin to reduce the clotting risk or anticoagulant medications, such as heparin or warfarin.

While people with lupus aren't at much risk for heart block, their children could be. In a small percentage of pregnancies in women with lupus, the unborn baby develops heart block in the womb. If caught early enough through fetal ultrasound, treating the mother with a steroid medication that passes the placenta may help arrest the problem. If steroid treatment is unsuccessful, the baby may require a pacemaker at birth.

Scleroderma: Just as the skin can harden and thicken in people with scleroderma, so can the blood vessels and internal organs, including the small blood vessels of the heart, the heart muscle itself and the heart lining. Symptoms, which are usually subtle, can include breathing difficulty upon exertion, heart palpitations and mild chest discomfort. If the heart is damaged badly enough, the result can be heart failure. Because heart failure is most common in people with hypertension, the best way to control scleroderma-related heart problems is to keep blood pressure under control.

Reactive arthritis: Heart inflammation in people with reactive arthritis, a form of arthritis that occurs following an infection of the genitourinary or gastrointestinal tract, can cause numerous problems including heart block (see Lyme disease, above) and valve damage. When severe, these problems may require placement of a pacemaker or replacement of valves.

http://www.arthritis.org/resources/arthritistoday/2000_archives/2000_11_12_heart_sb4.asp

Hugs, Jacy

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