Arthritis and blood pressure

Effects of Rheumatoid Arthritis on the Body

Overview

Rheumatoid arthritis (RA) is more than just joint pain. This chronic inflammatory autoimmune disease causes your body to mistakenly attack healthy joints and leads to widespread inflammation.

While RA is notorious for causing joint pain and inflammation, it can also cause other symptoms throughout the body. Read on to learn more about the possible symptoms of RA and its overall effects on the body.

The effects of rheumatoid arthritis on the body

RA is a progressive autoimmune disease that mainly affects your joints. According to Arthritis Foundation, about 1.5 million U.S. people live with RA.

Anyone can get RA, but it generally begins between the ages of 30 and 60. It also tends to affect women nearly three times more than men.

The exact cause of RA is unknown, but genetics, infections, or hormonal changes may play a role. Disease-modifying medications can help slow the progression of RA. Other medications, combined with lifestyle changes, can help manage the effects and in turn improve your overall quality of life.

Skeletal system

One of the first signs of RA is inflammation of the smaller joints in the hands and feet. Most of the time, symptoms affect both sides of the body at once.

Common symptoms include pain, swelling, tenderness, and stiffness, which is more pronounced in the morning. Morning RA pain can last for 30 minutes or longer.

RA can also cause tingling or burning sensations in the joints. Symptoms can come and go in “flares” followed by a period of remission, but the initial stages can last at least six weeks.

Symptoms of RA can occur in any of the body’s joints, including your:

  • fingers
  • wrists
  • shoulders
  • elbows
  • hips
  • knees
  • ankles
  • toes

RA can also result in:

  • bunions
  • claw toes
  • hammer toes

As the disease progresses, cartilage and bone are damaged and destroyed. Eventually, supporting tendons, ligaments, and muscles weaken. This can lead to a limited range of motion or difficulty moving the joints properly. In the long term, joints can become deformed.

Having RA also puts you at greater risk of developing osteoporosis, a weakening of the bones. This in turn can increase your risk of bone fractures and breaks.

Chronic inflammation of the wrists can lead to carpal tunnel syndrome, making it difficult to use your wrists and hands. Weakened or damaged bones in the neck or cervical spine can cause chronic pain.

Your doctor may order X-rays to investigate the extent of joint and bone damage from RA.

Circulatory system

RA can affect the system responsible for making and transporting blood throughout your body, too.

A simple blood test can reveal the presence of an antibody called the rheumatoid factor. Not all people with the antibody develop RA, but it’s one of many clues doctors use to diagnose this condition.

RA increases your risk for anemia. This is due to a decreased production of red blood cells. You may also have a higher risk of blocked or hardened arteries.

In rare cases, RA can lead to inflammation of the sac around the heart (pericarditis), the heart muscle (myocarditis), or even congestive heart failure.

A rare but serious complication of RA is inflammation of the blood vessels (rheumatoid vasculitis, or RA rash). Inflamed blood vessels weaken and expand or narrow, interfering with blood flow. This can lead to problems with the nerves, skin, heart, and brain.

Skin, eyes, and mouth

Rheumatoid nodules are hard lumps caused by inflammation that appear under the skin, usually near joints. They can be bothersome, but usually aren’t painful.

As many as 4 million U.S. people have an inflammatory disease called Sjogren’s syndrome, according to the Sjogren’s Syndrome Foundation. About half of these individuals also have RA or a similar autoimmune disease. When the two diseases are present, it’s called secondary Sjogren’s syndrome.

Sjogren’s causes severe dryness — especially of the eyes. You may notice a burning or gritty feeling. Prolonged dry eyes increases the risk of eye infection or corneal damage. Though it’s rare, RA can also cause inflammation of the eye.

Sjogren’s can also cause a dry mouth and throat, making it difficult to eat or swallow, especially dry foods. Chronic dry mouth can lead to:

  • tooth decay
  • gingivitis
  • oral infections

You may also experience swollen glands in the face and neck, dry nasal passages, and dry skin. Women may also feel vaginal dryness.

Respiratory system

RA increases the risk of inflammation or scarring of the linings of the lungs (pleurisy) and damage to lung tissue (rheumatoid lung). Other problems include:

  • blocked airways (bronchiolitis obliterans)
  • fluid in the chest (pleural effusion)
  • high blood pressure in the lungs (pulmonary hypertension)
  • scarring of the lungs (pulmonary fibrosis)
  • rheumatoid nodules on the lungs

Although RA can damage the respiratory system, not everyone has symptoms. Those who do may experience shortness of breath, coughing, and chest pains.

Immune system

Your immune system acts as an army, protecting you from harmful substances like viruses, bacteria, and toxins. It does this by producing antibodies to attack these invaders.

Occasionally, the immune system mistakenly identifies a healthy part of the body as a foreign invader. When that happens, antibodies attack healthy tissues.

In RA, your immune system attacks your joints. The result is intermittent or chronic inflammation throughout the body.

Autoimmune diseases are chronic, and treatment focuses on slowing progression and easing symptoms. It’s also possible to have more than one autoimmune disorder.

Other systems

The pain and discomfort of RA can make it difficult to sleep. RA may lead to extreme fatigue and a lack of energy. In some cases, RA flare-ups can cause flu-like symptoms such as:

  • short-term fever
  • sweating
  • lack of appetite

Early diagnosis and treatment may help slow the progression of RA. Disease-modifying medications, symptom relievers, and lifestyle changes can also greatly improve your quality of life.

It’s important to keep your doctor informed of any changes in symptoms you experience with your RA, so you can adjust your treatment plan as necessary.

What the New Blood Pressure Guidelines Mean for Rheumatoid Arthritis

Hypertension guidelines released at the end of 2017 redefine high blood pressure as 130/80 mmHg or higher. Several aspects of the new guidelines are especially important for people living with rheumatoid arthritis (RA).

Because RA poses higher risk of cardiovascular disease and people with RA are less likely to be diagnosed with hypertension even if symptomatic, they should heed the guidelines, said Christie Bartels, MD, MS, assistant professor, Rheumatology.

“Research shows you can reduce your risk of stroke if you can get down to 130/80,” said Dr. Bartels.

Keeping your primary care physician in the loop is important, emphasizes Dr. Bartels. “Patients may have gaps in preventive care. If three-quarters of their of visits are in a rheumatology clinic, the primary care physician might not be aware that levels have been elevated over time, and rheumatologists may not have blood pressure on their radar,” she said.

And no news about blood pressure does not necessarily translate to good news. “If the nurse doesn’t tell you what your numbers are, ask. Don’t assume it’s normal; it’s not always the case. It’s important to be an empowered patient so you can follow up,” said Dr. Bartels.

Resources:

  • “Rheumatoid Arthritis: What New Blood Pressure Guidelines Mean,” Everyday Health, January 9, 2018

Association between inflammation and systolic blood pressure in RA compared to patients without RA

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Dr. Gabriel concurs. “Because they don’t necessarily show cardiovascular symptoms the same way as other people, and because they take medication that other people aren’t on and have poorer outcomes when they develop heart disease, they need more specialized care,” she says.

The Cardio-Rheumatology Clinic enables early referral of patients with rheumatic diseases to cardiology. Patients have both a traditional cardiovascular risk assessment and a vascular health assessment. The results help create an individualized plan to manage risks and symptoms.

Regular follow-up visits monitor the effect of different treatment and prevention strategies on patients’ cardiovascular health. Dr. Mankad and her colleagues track this outcome information in a new database.

Dr. Mankad notes that cardiovascular treatment guidelines don’t exist for rheumatic conditions. Other conditions that carry an increased cardiovascular risk, such as diabetes, do have guidelines for target lipid levels, blood pressure and weight.

“The hope is to get to that point for rheumatoid arthritis patients by having a database to track how we’re treating these patients and seeing (whether) we have modulated the outcomes,” Dr. Mankad says. “It’s being very clinically driven.”

The Cardio-Rheumatology Clinic’s innovative practice gives physicians and patients the information they need to more accurately assess cardiovascular risk and to intervene much earlier. It paves the way for better management of heart disease and improved quality of life for people with rheumatic diseases.

“We’ve come full circle,” Dr. Gabriel notes. “Careful clinical observation led to research that now informs and changes clinical practice, making things better for patients.”

Dr. Mankad agrees. “This is an incredible niche,” she says. “Right now, we don’t know of any other place in the United States that has a specific cardio-rheumatology clinic. It’s very exciting.”

What Does High Blood Pressure Have to do With Osteoarthritis?

Initially, it may appear that high blood pressure and osteoarthritis are unrelated; however it is more than a coincidence that many individuals are diagnosed with both conditions. Both are inflammatory conditions (Fernandes, 2015). The relationship between osteoarthritis and hypertension is impacted by direct and indirect factors.

Obesity, High Blood Pressure, and Osteoarthritis

It’s well known that people who are overweight are more likely to have a diagnosis of high blood pressure than individuals who are thin or maintain a healthy weight. Individuals who are overweight or obese are often diagnosed with osteoarthritis which is caused by excessive pressure on their joints. The joints become inflamed and wear out. In these cases, healthcare providers need to encourage patients to lose weight in order to maintain the health of their bones and other connective tissues.

Arthritic Pain and Stress May Elevate Blood Pressure

Individuals who have osteoarthritis often suffer from joint pain and stress. Pain causes blood pressure to rise. Anxiety over a lack of independence and fears about debility may arise. Individuals who have severe osteoarthritis may require joint replacement surgery. Therefore, worries about surgery, finances, rehabilitation, and becoming incapacitated contribute to blood pressure elevation. For most individuals, the increase in blood pressure is slight. However, for individuals who have severe pain, anxiety, or hard-to-control hypertension, an elevation in blood pressure may precipitate life-threatening health conditions.

Non-steroidal anti-inflammatory medications, NSAIDs, are the most common medications used to treat individuals who are diagnosed with osteoarthritis. The use of NSAIDs can also directly affect blood pressure readings (Aljadhey, 2012). If the medications relieve pain effectively, they may cause the blood pressure to remain within normal limits. However, NSAIDs may cause hypertension.

Hypertension may result from two actions of the NSAIDs. Some NSAIDs reduce the effectiveness of medications which are used to treat hypertension. NSAIDS may cause sodium retention and as a result, fluids are retained and the blood pressure rises.

High Blood Pressure, Arthritis, and Diabetes

Researchers in Germany discovered that the most common comorbidities that people with diabetes have are hypertension and osteoarthritis. While having high blood pressure does not directly impede the quality of life among the study participants, a diagnosis of osteoarthritis resulted in more frequent medical treatments, higher levels of discomfort, and increased debility (Miksch, 2009).

Individuals who suffer from diabetes have higher rates of obesity than the general population. Due to this, they are more likely to suffer from surgical complications should joint replacement be needed.

The Bottom Line

It is important that healthcare providers be aware that individuals who suffer from diverse health challenges, such as hypertension and obesity, be aware of the relationship between the conditions. The public needs to be educated about risks and taught strategies which minimise the symptoms of osteoarthritis and hypertension. Healthcare providers need to be aware of the need for holistic treatments that reduce stress and pain. Individuals who have diabetes must be taught how to manage their blood pressure and maintain the health of their joints. It is essential that the risks and benefits of medications be evaluated when employing pharmaceuticals to manage arthritis symptoms. A holistic approach, which emphasises wellness, is likely to be the most effective way to prevent and manage the symptoms of hypertension and osteoarthritis.

  • Antje Miksch, Katja Hermann, Andreas Rölz, Stefanie Joos, Joachim Szecsenyi, Dominik Ose, and Thomas Rosemann. Additional impact of concomitant hypertension and osteoarthritis on quality of life among patients with type 2 diabetes in primary care in Germany – a cross-sectional survey. Health Qual Life Outcomes. 2009; 7: 19. Published online 2009 Feb 27. doi: 10.1186/1477-7525-7-19.
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Joint pain, back aches, and other musculoskeletal complaints are among the most prevalent health issues out there. When it comes to joint pain specifically (known as arthralgia), arthritis is the most common cause. But before you blame your achy joints on arthritis, did you know that everyday medications can cause joint pain too? Here are 10 common offenders.

1) Antibiotic — levofloxacin

Levofloxacin (Levaquin) belongs to a group of antibiotics known as “fluoroquinolones” and is commonly prescribed for sinus infections and pneumonia. Research shows that muscle and joint aches occur in 25% of folks taking this antibiotic — regardless of age, how long they take it, and whether or not they have a history of arthritis. Among those reporting joint aches, symptoms began three days after starting levofloxacin and resolved, on average, seven days after discontinuing it.

2) Cholesterol-lowering medications — statins

The group of cholesterol drugs known as “statins” are notorious for causing joint pain. Statins lower cholesterol levels by blocking the liver enzymes from making cholesterol. According to research, 10% of people taking rosuvastatin (Crestor) reported pain in their joints compared to 5% with atorvastatin (Lipitor) and 5% with lovastatin (Altoprev).

3) Osteoporosis medication — risedronate

Risedronate (Actonel) is a medication used to treat osteoporosis, a condition of weak and brittle bones. Risedronate prevents the minerals in bones from dissolving and leaking back into the bloodstream, but contributes to joint aches and pains in up to 30% of people taking it. Other osteoporosis medications like alendronate (Fosamax) and ibandronate (Boniva) — which belong to the same group of drugs as risedronate known as “bisphosphonates” — do not carry the same risk of joint pain.

4) Asthma inhaler — fluticasone

Fluticasone (Flovent) is a steroid inhaler used long-term to prevent asthma symptoms, but joint pain is reported in almost 19% of those using it. Ask your doctor about an alternative medication if you experience joint pain while taking it because other steroid inhalers like budesonide (Pulmicort), for example, come with fewer complaints of joint pain.

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5) Breast cancer medications — anastrozole, exemestane, letrozole

Anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara) are medications used in the treatment of breast cancer. They belong to a group of drugs known as “aromatase inhibitors” that either block estrogen hormones from being made or block estrogen’s effect on the body. These three medicines are usually taken for years to prevent breast cancer from recurring. Half of all women taking them experience joint pain.

6) Acne treatment — isotretinoin

Absorica and Accutane, including other oral isotretinoin medications, are used to treat severe acne. Back pain and joint aches are reported in more than 10% of folks taking it.

7) Antidepressant — venlafaxine ER

Venlafaxine ER (Effexor XR) is a type of medication known as an SNRI, a serotonin-norepinephrine re-uptake inhibitor. It increases levels of the neurotransmitters, serotonin and norepinephrine, in the brain and is prescribed for major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and other brain and nerve disorders. 10% of folks taking venlafaxine experience joint pain.

8) Nerve pain / anti-seizure medication — pregabalin

Pregabalin (Lyrica) is prescribed for certain kinds of nerve pain issues, like those related to fibromyalgia and diabetes, and is used to treat seizures. Joint pain occurs as a side effect in 6% of people taking it. If you experience joint pain with pregabalin, consider talking to your doctor about gabapentin (Neurontin), an alternative medication that is useful for many of the same conditions as pregabalin and yet does not carry the joint pain side effect.

9) Estrogen medication — Premarin

Premarin (conjugated estrogens) is a hormone medication that many women take to treat hot flashes and other symptoms related to menopause or low estrogen. Premarin causes joint pain in up to 14% of women taking it.

10) Blood pressure medication — carvedilol

Carvedilol (Coreg) is a type of medication known as a “beta-blocker”, which relaxes the muscle cells in the heart and blood vessels to lower blood pressure. Carvedilol is used to treat patients with high blood pressure and in cases of heart failure where the heart cannot adequately pump blood to the body. Joint aches and back pain are reported in almost 6% of patients taking it.

Dr O.

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  1. Musculoskeletal adverse drug reactions: a review of literature and data from ADR spontaneous reporting databases. Drug Safety. 2007; 2(1):47-63.
  2. Drug-induced musculoskeletal disorders. Drug Safety. 2007; 30(1):27-46.
  3. Managing joint pain in primary care. Journal of the American Board of Family Medicine. 2004; 17(Suppl):S32-S42.

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