Rheumatoid arthritis and chest pain



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit




Rheumatoid arthritis is the most common form of inflammatory arthritis.

(From the Arthritis Foundation and the American College of Rheumatology)

It primarily affects the joints and surrounding tissue. But it can also affect internal organs such as the lungs in several ways, including:

• Inflammation of the lining of the lungs (pleuritis), resulting in pain with breathing (pleurisy). Fluid also may accumulate around the lungs (pleural effusion) and cause shortness of breath. Treatment is directed at the underlying rheumatoid arthritis.
• Formation of small lumps (rheumatoid nodules) in the lungs. These nodules are often associated with widespread joint involvement and nodules in other parts of the body, eg.under the skin. A doctor may diagnose rheumatoid nodules based on a chest X-ray or computerized tomography scan.
• Scarring of the connective tissue, which supports the air sacs (alveoli) of the lungs (pulmonary fibrosis). The main symptom is shortness of breath. Treatment may include immunosuppressive medications such as corticosteroids.




Caplan's syndrome is inflammation and scarring of the lungs in people with rheumatoid arthritis who have exposure to coal dust.

Inhalation of coal dust causes inflammation and scarring of the lung. Persons with rheumatoid arthritis are more prone to develop larger areas of inflammation and scarring in response to coal dust. Caplan's syndrome is very rare in the US now. Patients will have cavitary lesions and occasionally chest pain also.

Lung injury can result from medications, and it is often impossible to predict who will develop lung disease resulting from a medication or drug. The types of lung diseases which can result from medications include: allergic reactions (asthma, hypersensitivity pneumonitis, or eosinophilic pneumonia), an undesirable side effect such as coughing or bronchitis, inflammation of the lung air sacks (pneumonitis or infiltration), interstitial fibrosis (scarring), pulmonary edema, alveolar hemorrhage (bleeding into the lung air sacks), pleural effusion, lung vasculitis, mediastinal inflammation, swollen lymph nodes (lymphadenopathy), respiratory failure, and granulomatous lung disease.



Pericarditis is a disorder caused by inflammation of the pericardium, which is the sac-like covering of the heart.



Previous research has revealed that rheumatoid arthritis patients have a higher risk of early death, most likely due to cardiovascular disease.

Mayo Clinic researchers have concluded from a study that not only do people with rheumatoid arthritis have a higher risk of coronary heart disease than the general population, they have:

• more silent, unrecognized heart attacks.
• more sudden cardiac deaths.
Interestingly, however, rheumatoid arthritis patients are much less likely to complain of chest pain. This may because of their high pain threshold.

Mayo Clinic researchers studied 603 Rochester residents diagnosed with rheumatoid arthritis between January 1, 1955 and January 1, 1995.

Researchers compared that group to 603 Rochester residents of the same ages and gender who did not have rheumatoid arthritis. Both groups were followed up for a median of 26 years before rheumatoid arthritis diagnosis and 15 years after diagnosis. Information was gathered about all study participants, focusing on cardiac events and traditional cardiovascular risk factors such as diabetes, blood pressure, cholesterol, body mass index, and smoking.

Researchers believe the increased heart disease risk may exist even prior to the diagnosis of rheumatoid arthritis. During the two years before diagnosis with rheumatoid arthritis, people with rheumatoid arthritis were:

• three times more likely to have been hospitalized for an acute heart attack.
• less likely to have a history of chest pains.
• five times more likely to have an unrecognized heart attack.
After diagnosis with rheumatoid arthritis, this group was:
• twice as likely to have unrecognized heart attacks and sudden cardiac deaths.


Mayo Clinic researchers drew three important conclusions from the findings and suggested rheumatoid arthritis patients need to be aware:

• The risk of heart attack already exists by the time the diagnosis of rheumatoid arthritis is first made.
• Heart disease can be silent in people with rheumatoid arthritis, making regular cardiac checkups necessary as well as lowering traditional cardiac risk factors (blood pressure, cholesterol, smoking).
• In rheumatoid arthritis patients, the first evidence of heart disease can occur as cardiac sudden death.
Researchers believe that in rheumatoid arthritis patients, more than one factor is contributing to the association with heart disease, other than the so-called traditional risk factors for heart disease. It has been theorized that rheumatoid arthritis and heart disease have a common origin, and that the systemic inflammation involved in rheumatoid arthritis might also promote cardiovascular disease and cardiovascular death.

Mayo Clinic researchers emphasize that rheumatoid arthritis patients must recognize that they have a higher risk for heart disease. Rheumatoid arthritis patients must be vigilant about any cardiac symptoms they may experience, and seek prompt medical care if that occurs. Researchers also suggest that possibly rheumatoid arthritis patients take so many painkillers to control joint pain, they do not recognize or feel chest pain the same way a person would who does not take painkillers.




Get more information about rheumatoid arthritis and related conditions as well as...


• Insider arthritis tips that help you erase the pain and fatigue of rheumatoid arthritis almost overnight!

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• And much more...


Click here Second Opinion Arthritis Treatment Kit








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