Heart Failure and Rheumatoid Arthritis - British Heart Fou...

British Heart Foundation
15,971 members10,429 posts

Heart Failure and Rheumatoid Arthritis


I have rheumatoid arthritis which was well controlled with methotrexate until I was diagnosed with heart failure in October 2018. I was put on the usual drugs for heart failure, beta blockers, diuretics and candesartan (couldn't tolerate Ramipil - terrible cough). I was also told to stop methotrexate as it is possible this contributed to my heart failure. A year on my heart failure has improved, EF up from low to mid 30's to around 50. But my rheumatoid arthritis is now very active. Recently I had to have a course of steroids to bring it under control. I asked my Cardiologist if I could go back on methotrexate and he said it is my choice but I came off it and my heart failure improved, he can't rule out methotrexate as a potential cause of my heart failure. My rheumatologist says he has never know methotrexate to cause heart failure. I don't know what to do, I'm scared to go back on methotrexate in case it makes my heart failure worse, but my rheumatoid arthritis can be debilitating. I just wondered if anyone else has rheumatoid arthritis and heart failure and how you are treated/manage? Thank you.

4 Replies

Morning gracieOS, I have had RA since i was 7, and tried everything. Methotrexate upset my liver so it had to stopped. By now i was in my 40s. The pain and lack of mobility caused me to have 2 knees and 1 shoulder replacements , in 2017 I started on biologics (beni pali) then was diagnosed with emphesema , it just never stopped,then early 2019 I was diagnosed with heart failure after 6 months of non stop AF. I had a large ulcer on my leg, short of breath and joint pain. The beni pali was stopped, and currently I only take pain relieve for thr RA. I have an appt with rheumatologist February. Its difficult to say what helps or not as we are all different. I feel better with inhalers ramipiral and bisoprolol, knowing nothing is being made worse with strong drugs, but the pain and tiredness is debilitating. Do what you think is best for you, take care Jane. Onwards and upwards x

Hi Gracie,

That seems an odd one.

I'm certainly not a doctor but a quick half hour or so of going through the literature suggests that every study I can find shows methotrexate as, if anything, helping to protect agains the CHF which RA can produce.

I didn't find anything later than about 2010 so perhaps there's been new evidence since then but, in your situation, I think I'd like to know what the cardiologist has based his opinion on.

It seems more likely that the other, established, HF treatments you started at the same time as stopping the methotrexate could account for the improvement in your EF.

Eta: incidentally, that's a really good improvement! If they can get the RA controlled as well you'll feel like a new woman :)


I have Ankylosing Spondylitis and one of the rarer auto immune arthritis diseases, I take Methotrexate and an anti TNF ( Biologic drug ). I have developed micro vascular angina and have a thoracic aortic aneurysm, my only risk factor is my auto immune diseases. Methotrexate and some of the Biologic drugs are known to be cardio protective.

Rheumatoid Arthritis ( and other auto immune diseases ) are recognised as causing cardiac problems, simply put the heart doesn’t like inflammation. My question would be what damage is being done whilst your RA is flaring, repeated courses of prednisolone isn’t the answer due to side effects such as weight gain, increased blood sugars and cholesterol, infection risk.

Are your cardiologist and rheumatologist in contact with each other, is anyone looking at you and your needs holistically? My experience has been that each specialist tends to look at their own specialist “ bit “ or organ. There are many new drugs on the market for treating RA, I know that some are contraindicated in heart failure, it sounds like you need to sit down with both specialists and discuss the risks and benefits of further treatment.

in reply to Brussels

Unfortunately, as with your experience, each specialist is focussing on thier specialism. Little cross talk. I have a GP appointment coming up to review current steroids, I think I'll ask him for his opinion. I'm tempted to go back on methotrexate but ask for an echocardiogram in 3 to 4 months to see what, if any, impact methotrexate is having on my heart function.

You may also like...