Prevention of Stroke in Rheumatoid Arthritis

  • Alicia M. Zha
  • Mario Di Napoli
  • Réza BehrouzEmail author
Stroke (HP Adams, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Stroke


The risk of cerebrovascular disease is increased among rheumatoid arthritis (RA) patients and remains an underserved area of medical need. Only a minor proportion of RA patients achieve suitable stroke prevention. Classical cardiovascular risk factors appear to be under-diagnosed and undertreated among patients with RA. Reducing the inflammatory burden is also necessary to lower the cardiovascular risk. An adequate control of disease activity and cerebrovascular risk assessment using national guidelines should be recommended for all patients with RA. For patients with a documented history of cerebrovascular or cardiovascular risk factors, smoking cessation and corticosteroids and non-steroidal anti-inflammatory drugs at the lowest dose possible are crucial. Risk score models should be adapted for patients with RA by introducing a 1.5 multiplication factor, and their results interpreted to appropriately direct clinical care. Statins, angiotensin-converting enzyme inhibitors, and angiotensin-II receptor blockers are preferred treatment options. Biologic and non-biologic disease-modifying anti-rheumatic drugs should be initiated early to mitigate the necessity of symptom control drugs and to achieve early alleviation of the inflammatory state. Early control can improve vascular compliance, decrease atherosclerosis, improve overall lipid and metabolic profiles, and reduce the incidence of heart disease that may lead to atrial fibrillation. In patients with significant cervical spine involvement, early intervention and improved disease control are necessary and may prevent further mechanical vascular injury.


Rheumatoid arthritis Stroke Cerebrovascular disease Risk factors Autoimmune disease Inflammation 


Compliance with Ethical Standards

Conflict of Interest

Alicia M. Zha, Mario Di Napoli, and Réza Behrouz declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Alicia M. Zha
    • 1
  • Mario Di Napoli
    • 2
    • 3
  • Réza Behrouz
    • 4
    Email author
  1. 1.Department of NeurologyThe Ohio State University College of MedicineColumbusUSA
  2. 2.Neurological ServiceSan Camillo de’ Lellis General HospitalRietiItaly
  3. 3.SMDN-Neurological SectionCentre for Cardiovascular Medicine and Cerebrovascular Disease PreventionSulmonaItaly
  4. 4.Department of Neurology, School of MedicineUniversity of Texas Health Science Center San Antonio, Medical Arts and Research CenterSan AntonioUSA

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