Quick answer: Inflammatory types of arthritis, such as rheumatoid arthritis, psoriatic arthritis, lupus and gout, are linked with a higher risk of heart disease and stroke. Ongoing inflammation can damage blood vessels, and some medicines and reduced activity add to the risk. Keeping inflammation well controlled, not smoking, staying active and having regular blood pressure, cholesterol and blood sugar checks all help lower it.
Why arthritis can affect your heart
Inflammation is not confined to the joints. In inflammatory arthritis, the same immune processes that cause joint swelling circulate in the blood and can affect the lining of blood vessels. Over time this can speed up the build-up of fatty plaques in the arteries (atherosclerosis), which can lead to heart attacks and strokes. Inflammation can also affect the heart muscle and its lining in some conditions.
The conditions most clearly linked with higher heart and circulation risk include rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, lupus and gout. Osteoarthritis is not an inflammatory disease in the same way, but pain and reduced activity can still affect heart health, and people with osteoarthritis often share risk factors such as higher weight.
Other things that add to the risk
- Traditional risk factors: smoking, high blood pressure, high cholesterol, diabetes, being overweight, family history and older age all matter as much for people with arthritis as for anyone else.
- Less activity: pain, stiffness and fatigue can make it harder to stay active, which affects blood pressure, weight and fitness.
- Some medicines: steroid tablets can raise blood pressure, blood sugar and weight. Anti-inflammatory painkillers (NSAIDs) can raise blood pressure and, particularly with long-term or higher-dose use, the risk of heart attack and stroke.
- Uncontrolled disease: more inflammation over time appears to mean more risk.
Checks to ask your GP about
Heart disease often has no symptoms until something goes wrong, so regular checks are important. It is worth asking your GP practice about:
- A cardiovascular risk assessment. GPs often use a tool called QRISK3, which estimates your 10-year risk of heart attack or stroke. It includes rheumatoid arthritis and lupus as risk factors, so make sure your diagnosis is recorded.
- Blood pressure at least once a year, and more often if it is raised or you take medicines that can increase it.
- Cholesterol tests. Active inflammation can make cholesterol results harder to interpret, so your GP may repeat them when your arthritis is under better control.
- Blood sugar (HbA1c), particularly if you take steroids.
- An NHS Health Check if you are aged 40 to 74 in England and have not already been diagnosed with heart disease. Similar checks may be available elsewhere in the UK.
How arthritis treatment fits in
Controlling inflammation well is one of the best things you can do for your heart as well as your joints. Research suggests that effective treatment of inflammatory arthritis is linked with lower heart risk, which is another reason to keep taking your DMARD or biologic as prescribed.
- Steroids are very useful for controlling flares, but your team will aim to use the lowest effective dose for the shortest time. See our steroids guide.
- NSAIDs should be used at the lowest effective dose for the shortest time, and some people with heart disease or high risk may be advised to avoid them. See our guide to safer NSAID use.
- JAK inhibitors carry specific warnings about heart and blood clot risks in people over 65, smokers and those with other heart risk factors. Your rheumatologist will weigh these up when choosing treatment.
- Other medicines, such as hydroxychloroquine, can rarely affect heart rhythm, and leflunomide can raise blood pressure. Your team monitors for these.
Do not stop or change any arthritis medicine because of heart worries without talking to your team first. Stopping treatment can lead to flares, which carry their own risks.
Lifestyle steps that make the biggest difference
Stop smoking
Smoking is one of the strongest risk factors for heart disease. It is also linked with more severe rheumatoid arthritis and can make some treatments work less well. Free NHS stop smoking services, your pharmacist and the NHS Quit Smoking app can help.
Move more, in ways that suit your joints
Regular physical activity lowers blood pressure, improves cholesterol and helps with weight, mood and sleep. UK guidance suggests building up towards at least 150 minutes of moderate activity each week, plus strength exercises twice a week. Walking, swimming, cycling and water exercise are often joint-friendly. See our walking guide and exercise guide.
Eat for your heart
A Mediterranean-style pattern, with plenty of vegetables, fruit, wholegrains, beans, nuts, olive oil and oily fish, and less processed meat, salt and sugar, supports heart health and fits well with arthritis. See our diet guide.
Keep a healthy weight
Losing weight if you are carrying extra reduces strain on the heart and on weight-bearing joints. Your GP can refer you to weight management support.
Alcohol, sleep and stress
Keep alcohol within UK low-risk guidelines, aim for regular sleep, and find ways to manage stress. These all affect blood pressure.
Know the warning signs
Call 999 if you have chest pain or pressure that spreads to your arm, neck, jaw or back, especially with breathlessness, sweating or feeling sick. Also call 999 for signs of a stroke: face drooping, arm weakness or speech problems. See your GP soon if you notice new breathlessness on exertion, swollen ankles or palpitations.
Frequently asked questions
Does rheumatoid arthritis increase the risk of heart disease?
Yes. People with rheumatoid arthritis have a higher risk of heart attacks and strokes than the general population, largely because of inflammation. Good disease control and managing traditional risk factors help.
Is osteoarthritis linked to heart disease?
Osteoarthritis is not an inflammatory disease in the same way, but reduced activity and shared risk factors, such as higher weight, can affect heart health.
Are NSAIDs bad for your heart?
NSAIDs can raise blood pressure and increase heart and stroke risk, particularly with long-term or higher-dose use. Use them at the lowest effective dose for the shortest time, and ask your GP or pharmacist if you have heart risks.
What is QRISK3?
A tool GPs use to estimate your 10-year risk of heart attack or stroke. It includes rheumatoid arthritis and lupus as risk factors.
Can arthritis medicines protect my heart?
Controlling inflammation effectively appears to be linked with lower heart risk. Keep taking your medicines as prescribed and discuss any concerns with your team.
Should I have a statin?
That depends on your overall risk. Your GP will discuss your risk assessment and whether a statin is right for you.
Sources and further reading
- NICE NG238: Cardiovascular disease risk assessment and reduction
- NHS: Cardiovascular disease
- NHS: NHS Health Check
- NHS: Quit smoking
This guide is for general education and is not a substitute for personal medical advice. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.