Arthritis Patients Missing Out on Aspirin Therapy

By Randy Dotinga

As preventive measures go, it's a pretty simple one: People with rheumatoid arthritis are more likely to develop heart disease, so they should take a low-dose aspirin once a day.

But new research suggests many patients aren't getting the message, potentially putting them at risk.

Researchers found that just 18 percent of rheumatoid arthritis patients are on aspirin therapy, widely considered an effective and inexpensive way to prevent heart attacks. Meanwhile, a similar group of people with other types of arthritis are significantly more likely to take aspirin each day -- 25 percent of them do so, the study found.

The reason for the oversight isn't clear, but it may have something to do with rheumatologists and primary-care doctors failing to consider a patient's overall health, said Dr. Eric Ruderman, an associate professor of medicine at Northwestern University's Feinberg School of Medicine. "Maybe we're not looking at the rest of the picture as much as we should," he said.

Rheumatoid arthritis is caused when the immune system begins attacking the body itself, causing pain and inflammation in the joints. It's one of the most serious and disabling types of arthritis, is most common among women, and often begins when people are in their 30s and 40s.

By contrast, osteoarthritis is caused when the cartilage that covers the ends of bones in the joint deteriorates, producing pain and loss of movement as bone begins to rub against bone, according to the Arthritis Foundation.

For reasons that aren't entirely clear, people with rheumatoid arthritis are twice as likely to develop heart disease, said study co-author Dr. Lee Colglazier, a rheumatologist in Crestview Hills, Ky., who worked on the study as a rheumatology fellow at Wake Forest University School of Medicine. Some theories suggest the inflammation triggered by arthritis contributes to cholesterol buildup and artery blockages.

Colglazier and colleagues are scheduled to report their findings Wednesday at the American College of Rheumatology annual meeting, in San Diego.

For the study, the researchers surveyed 18,123 arthritis patients, most of whom -- 14,114 -- had the rheumatoid form, over a three-year period.

Of the rheumatoid arthritis patients, only 18.4 percent took an aspirin a day to prevent heart disease, compared to 25.1 percent of the patients with other forms of arthritis.

Doctors believe that a simple low-dose -- or "baby" -- aspirin once a day, which costs pennies, can reduce the risk of heart attacks.

The findings are mystifying, especially because rheumatoid-arthritis patients are hardly strangers at doctor's offices, Colglazier said. "Maybe they're seeing the doctor a lot, a lot of acute things are going on, (but) doctors don't have time to say, 'Let's address prevention.'"

Ruderman agreed, adding that primary-care doctors might not realize the heart-risk urgency facing rheumatoid arthritis patients. Perhaps "they don't view these patients with the same concern that they may view a diabetic or a patient with significant hypertension or elevated cholesterol," he said.