Are Joint Pain and Heart Disease Connected?

Achy joints qualify as the most well-known symptom of rheumatoid arthritis (RA). But did you know that the chronic joint condition also can increase your risk of heart disease?


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People with RA tend to have higher rates of cardiovascular disease and elevated risk for serious cardiac events (such as a heart attack) with worse outcomes. The association can be a deadly one, too.

To explain how creaky joints relate to the health of your ticker, we turn to rheumatologist M. Elaine Husni, MD, MPH, and cardiologist Steven Nissen, MD.

Inflammation: The common connection

RA is an autoimmune disease that’s a progressive form of inflammatory joint disease. The condition typically targets smaller joints (like those in your hands or feet).

Uncontrolled inflammation that comes with RA damages shock-absorbing cartilage within your joints. The result is typically pain and swelling in the affected joint. Eventually, RA can lead to deformities that destabilize joints.

But that inflammation doesn’t just affect your body’s bendy parts. It hits other areas, too, including your heart, says Dr. Husni and Dr. Nissen.

The chronic inflammation that comes with RA can accelerate scarring and narrowing of your arteries, a condition known as atherosclerosis. This “hardening of the arteries” gradually slows blood flow to your heart and other organs.

Research offers large amounts of evidence linking RA and atherosclerosis, which can lead to heart disease. (The relative risk of heart disease for those with RA is in the range of or similar to other important risk factors, such as smoking.)

“There is a very strong association of accelerated heart disease in patients with various types of inflammatory arthritis, such as RA, lupus and psoriatic arthritis,” says Dr. Husni, Vice Chair of Rheumatology and Director of Cleveland Clinic’s Arthritis and Musculoskeletal Center.

Studies also connect inflammation from RA to an increased risk of atrial fibrillation and the heart and health concerns the condition brings.

Other related risk factors

People with RA also tend to have accompanying health issues that increase the risk of heart disease, according to the Arthritis Foundation. The list includes:

  • Obesity.
  • High blood pressure (hypertension).
  • Cholesterol levels.

Smoking also is considered a leading risk factor for RA and — as you might imagine — it’s not great for your heart either. Puffing on cigarettes has been connected to about 1 in 4 deaths from cardiovascular disease.

Steps to minimize heart disease risk with RA

Lowering heart disease risk from RA begins with establishing and following a treatment plan to help manage inflammation. Regular visits to your rheumatologist for exams and tests can also help manage symptoms of RA.

Less inflammation puts less strain on your cardiovascular system, which — as outlined ­— is pretty important, notes Dr. Nissen, Chairman of Cleveland Clinic’s Department of Cardiovascular Medicine.

Plus, reducing inflammation can help decrease some of those other related risk factors, as also noted. (Win-win!)

Other recommendations include:

  • Get an annual cardiovascular risk assessment. “I suggest that people with RA get screened by their doctor for cardiovascular risk factors like cholesterol and blood pressure,” advises Dr. Nissen. These risk factors are easier to address sooner than later, too.
  • Increase activity. Movement is important for managing RA. Start slowly and adopt an exercise routine that fits your current fitness level. You may find exercising in a pool easier at first until you build more strength. (Get tips on exercising with arthritis from an orthopaedic rehabilitation specialist.)
  • Eat a healthy diet. There isn’t an “RA diet,” per se, but choosing foods that are nutrient-dense, plant-based and not processed is best. (Want to know where to start to build a well-balanced food plan? A dietitian offers dietary tips for living with RA.)
  • Stop smoking. There’s a reason why cigarettes come with 11 different health warning labels. Finding a way to kick the habit can bring instant health benefits. Try these methods to quit smoking.
  • Manage stress. Your body’s natural response to stress can worsen the inflammation and pain of RA. Learning ways to manage your day-to-day stress can limit flare-ups. (Here are five ways to relax and destress.)
  • Catch enough ZZZs. Sleep can be restorative for your body and help limit the pain of RA. (Try these seven tips for a better night’s sleep.)

Final thoughts

Increased awareness of the strong connection between RA and heart disease is essential to improve long-term health outcomes. Too often, the link between the conditions has been underestimated.

Bottom line?

“If you have RA, talk to your rheumatologist about all the different ways RA can affect your body even beyond the joint issues,” recommends Dr. Husni. “Make aggressive cardiovascular risk factor screening and management a priority.”


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