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 Researchers linked anger, anxiety, depressive symptoms, job stress
and low social support to increasing risk of hardening of the
arteries, or atherosclerosis, for people with rheumatoid arthritis
(RA).
Treating psychosocial problems may help ease arthritis symptoms as
well as decrease the risk of death from cardiovascular disease, the
study team concludes in the journal Arthritis Care and Research.
Unlike osteoarthritis, which is mostly associated with wear-and-tear
on joints with age, rheumatoid arthritis is an autoimmune disease
that can strike at any point in life. The body’s immune system
starts attacking the joints, causing swelling and pain. People with
RA also tend to have increased inflammation.
The inflammation is most evident in the joints but is present
"systemically" in many parts of the body, Dr. Peter Ganz told
Reuters Health by email.
Inflammation is also a key component of atherosclerosis, from its
beginning to its ultimate consequences, like heart attack and
stroke, said Dr. Ganz, chief of cardiology at San Francisco General
Hospital, who was not involved in the study.
When someone has both conditions, he said, the RA intensifies the
inflammatory processes in the arteries, making the plaques worsen
more rapidly and raising the risk of heart attacks, strokes and
other complications.
Psychosocial stresses also increase inflammation, he said.
“So now you might have a triple whammy – inflammation from
atherosclerosis, RA and psychosocial stresses all converge in the
same patient,” Ganz said.
For the new study, Dr. Jon T. Giles of Columbia University College
of Physicians & Surgeons in New York City and colleagues compared
195 patients with RA and no history of heart problems to more than
1,000 similar adults without arthritis.
Compared to the non-arthritis group, those with RA had more
depressive symptoms, higher personal health stress, higher job
stress and lower relationship stress. RA patients tended to have
less anger than the comparison group.
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In the RA group, higher anxiety scores, anger scores, more symptoms
of depression, and stress due to caring for a loved one were
associated with increased odds of coronary artery calcium. There was
no relation between these psychosocial factors and artery calcium in
the comparison group.
For people with RA, job stress also increased the risk of plaque in
the carotid artery in the neck, which helps supply blood to the
brain.
Depression may be up to four times as common for people with RA
compared to the general population, said Dr. Ivana Hollan of the
Hospital for Rheumatic Diseases in Lillehammer, Norway.
“Emotional changes seem to have a causal role in cardiovascular
disease,” Hollan, who was not involved in the new research, told
Reuters Health by email.
Depression increases the risk for cardiovascular disease, and among
those who have cardiovascular disease, depression predicts worse
disease outcomes, she said.
The treatment of psychosocial conditions, such as depression,
“appears important as these conditions have health effects beyond
their impact on mood,” Hollan said.
Based on this study, RA patients should try to reduce stresses in
their lives, perhaps with counseling, Ganz said.
“Lifestyle improvements (exercise, healthy diet, weight control,
cessation of smoking) should be encouraged and pharmacological
approaches (e.g. statins for cholesterol reduction, aspirin) should
be considered to reduce cardiovascular risk,” he said.
SOURCE: http://bit.ly/1htbppl Arthritis Care and Research, August
13, 2015.
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