Why Rheumatologists Must Prioritize Heart Health for AiArthritis Patients

Heart health doesn’t always get the attention it deserves in autoimmune and autoinflammatory arthritis (AiArthritis) disease care. At day 3  of ACR 2025, one session made it clear that this needs to change. Tiffany Westrich Robertson, CEO and founder of AiArthritis and someone living with non-radiographic axial spondyloarthritis, shared updates from a session focused on what researchers are now calling cardiac immunology or cardiac rheumatology.

The message was direct and urgent. Chronic inflammatory diseases significantly increase cardiovascular risk and this risk must be taken just as seriously as joint damage or disease flares.

AiArthritis Diseases and the Heart Are Deeply Connected

Researchers emphasized that people living with AiArthritis diseases are at higher risk for heart disease and heart failure than the general population. In fact, updated cardiovascular guidelines have shown that chronic inflammatory diseases can pose a higher heart failure risk than even hypertension – a risk factor most people are familiar with.

This increased risk is not theoretical. It is tied directly to immune system activity. The heart contains a large number of immune cells called leukocytes – roughly twelve times more than are found in skeletal muscle. These immune cells play a role in inflammation patterns. When the immune system is overactive, as it is in autoimmune disease, the heart becomes more vulnerable to inflammatory damage.

Understanding Cardiac Inflammation

The session focused closely on conditions such as pericarditis (inflammation of the lining around the heart) and myocarditis (inflammation of the heart muscle itself). Both conditions can occur in people with AiArthritis diseases and may be overlooked if symptoms are subtle or attributed to other causes.

Because AiArthritis diseases are systemic, meaning they affect the whole body, inflammation does not stay confined to joints or skin. Even when symptoms feel manageable, ongoing disease activity can still affect organs such as the heart.

What Science Is Teaching Us About Treatment

Much of the discussion highlighted how immune-targeted therapies may help protect the heart. Researchers are studying interleukins, which are signaling molecules in the immune system and common targets of biologic medications.

Early and ongoing research suggests that certain interleukin pathways play a role in heart inflammation. Interleukin-10 has shown promise in regulating inflammation, while interleukin-1 has emerged as a particularly important target in cases of heart involvement.

This matters clinically. International recommendations published in 2014 now identify interleukin-1–targeting therapies as the preferred second-line option for patients with inflammatory heart involvement when standard treatments, including steroids, are not effective. Second-line means these therapies are used when first approaches fail to adequately control the condition.

Why This Should Change Everyday Care

One of the strongest takeaways from this session was a call to action for rheumatologists. Cardiovascular health should not be an afterthought or something left entirely to primary care or cardiology.

People with autoimmune and autoinflammatory arthritis often live with ongoing inflammation, even between flares. That inflammation alone increases cardiovascular risk. Monitoring heart health, recognizing warning signs, and treating systemic inflammation aggressively and appropriately are essential parts of comprehensive care.

For patients, this reinforces the importance of speaking up about symptoms such as chest pain, shortness of breath, unexplained fatigue, or palpitations. It also means understanding that managing disease activity is not only about reducing pain or stiffness, but also about protecting long-term organ health.

The Bigger Picture

This session reinforced something many in the patient community have been saying for years. AiArthritis diseases affect the entire body. The heart is not separate from the immune system, and inflammation anywhere can have consequences everywhere.

By prioritizing heart health as part of routine AiArthritis disease care, clinicians can help reduce long-term risk and improve outcomes. Education, early intervention, and targeted treatment all play a role.

At AiArthritis, the goal of sharing these updates is to help patients understand why comprehensive care matters and to give them the knowledge needed to advocate for it. Heart health is not optional. It is a vital part of living well with AiArthritis diseases.