Inflammatory arthritis — which includes conditions such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and gout — has long been associated with an increased risk of cardiovascular disease. In short, these forms of arthritis cause systemic inflammation that may damage your circulatory system.
While that damage can certainly put you at risk for a heart attack, the trouble doesn’t stop there. Changes in your vessels and arteries may also increase your risk of having a stroke (also known as a brain attack), which occurs when blood flow to your brain is impeded thanks to a blood clot or burst blood vessel.
This information isn’t brand new. In 2016 researchers writing in the journal Stroke concluded that having RA or systemic lupus erythematosus (SLE) can increase a person’s risk for stroke by 60 to 100 percent compared to the general population. In recent years the evidence connecting stroke to rheumatic diseases has continued to mount.
To summarize the latest evidence, a group of scientists from China analyzed 52 international studies on stroke and rheumatic disease, culminating in “the most comprehensive systematic review and meta-analysis of published cohort studies to evaluate the stroke risk in arthritis.” Their findings were published in the journal PLOS ONE.
As the authors pointed out, the studies included in this analysis were observational, so they can’t prove that having inflammatory arthritis directly causes an increased stroke risk. But the researchers attempted to remove other possible confounding factors through their study selections. For starters, they only analyzed studies that had already adjusted for age and biological sex. They also focused heavily on studies that adjusted for at least one other traditional stroke risk factor, such as hypertension, diabetes, smoking, alcoholism, obesity, physical inactivity, and high cholesterol.
Overall, the researchers found that people with arthritis had a 36 percent higher stroke risk compared to the general population. When analyzing the risk of stroke by type of arthritis, researchers found the following:
- Rheumatoid arthritis patients’ odds of being at risk of a stroke were 1.38 times higher than the general population.
- Psoriatic arthritis patients’ odds of being at risk of a stroke were 1.33 times higher than the general population.
- Ankylosing spondylitis patients’ odds of being at risk of a stroke were 1.49 times higher than the general population.
- Gout patients’ odds of being at risk of a stroke were 1.40 times higher than the general population.
Though osteoarthritis (OA) is not a form of inflammatory arthritis, researchers also looked at the stroke risk for people with osteoarthritis. They found that OA patients had the same risk for stroke as the general population.
The authors also found that younger patients were at greater risk than middle-aged aged and older ones. That’s particularly notable because, in general, getting older raises your stroke risk.
“As young people ordinarily have fewer traditional [risk factors for stroke], we speculate that arthritis is an independent risk factor,” they wrote.
The researchers acknowledged that larger studies are needed to “explore the effects of different types of arthritis on stroke.” Additionally, they wrote that further studies are needed to identify improved treatments for different types of arthritis in relation to stroke risks.
Although the link between inflammatory arthritis and stroke risk can be alarming, patients are not powerless. Earlier studies have suggested that there are many ways to reduce this threat. Keeping your rheumatic condition well-controlled with biologic and/or traditional disease-modifying antirheumatic drugs should help by taming inflammation. Controlling other stroke risk factors, such as blood pressure and cholesterol by making lifestyle changes and, in certain cases, taking medication, is also important.
Rheumatic disease patients who are concerned about stroke risk should avoid smoking and use the lowest possible effective dose of corticosteroids and non-steroidal anti-inflammatory drugs.
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Liu W, et al. Stroke risk in arthritis: A systematic review and meta-analysis of cohort studies. PLOS ONE 16(3): March 6, 2021: doi: https://doi.org/10.1371/journal.pone.0248564.
Wiseman SJ, et al. Cerebrovascular Disease in Rheumatic Diseases: A Systematic Review and Meta-Analysis. Stroke. February 25, 2016. doi: https://doi.org/10.1161/STROKEAHA.115.012052.
Zha AM, et al. Prevention of Stroke in Rheumatoid Arthritis. Current Neurology and Neuroscience Reports. October 20, 2015. doi: https://doi.org/10.1007/s11910-015-0600-y.