Rheumatoid Arthritis and Death

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The other day, I heard someone say, "Well,rheumatoid arthritis doesn't kill you." Not wanting to get into a long, involved conversation at the time, I muttered inaudibly, "Actually, it's more complicated than that."

Rheumatoid arthritis is not generally considered a fatal or terminal disease. In fact, it is commonly referred to as a chronic disease, meaning that you will have it for the duration of your life. The disease is linked to a higher risk of complications that can be fatal, though.

Rheumatoid arthritis is associated with reduced life expectancy, in large part due to the complications which can develop. It has been estimated that life expectancy can be cut by approximately 10 years for people with rheumatoid arthritis. Systemic inflammation related to rheumatoid arthritis is thought to indirectly cause the shortened lifespan, as well as play a role in heightening the risk of serious infection, cardiovascular disease, atherosclerosis, and metabolic disease -- any of which could contribute to premature death.

Cardiovascular Disease

The link between rheumatoid arthritis and increased cardiovascular disease has been well-studied and continues to be a focus of research. Cardiovascular disease is the leading cause of death among rheumatoid arthritis patients. Approximately 40% of deaths in rheumatoid arthritis are attributed to cardiovascular events.

People with rheumatoid arthritis have a two-fold increased risk of heart attack or stroke compared to people without rheumatoid arthritis. The risk escalates to nearly three-fold in patients who have had rheumatoid arthritis for 10 or more years.

Interestingly though, usual risk factors for cardiovascular disease don't explain the whole picture in people with rheumatoid arthritis. There are other pathogenic (disease-causing) mechanisms at play, primarily related to systemic inflammation. Such mechanisms may include pro-oxidative dyslipidemia (abnormal levels of fat in the blood), insulin resistance, predisposition to blood clots, high levels of homocysteine in the blood, and certain immune functions, such as T-cell activation.

Yet another interesting point -- rheumatoid arthritis patients are less likely to report chest pains than those without rheumatoid arthritis. They are more inclined to experience unrecognized myocardial infarction (heart attack) or sudden cardiac death.

Metabolic Syndrome

Metabolic syndrome, a cluster of traditional cardiovascular risk factors, including hypertension, obesity, glucose intolerance, and dyslipidemia is highly prevalent in patients with rheumatoid arthritis. Higher inflammatory markers and the use of glucocorticoids are considered predictors of the presence of metabolic syndrome in patients with rheumatoid arthritis.

One study, published in the January 2011 issue of the Journal of Rheumatologyconsidered whether rheumatoid arthritis patients without obvious signs of cardiovascular disease had a higher prevalence of metabolic syndrome. The conclusion was that rheumatoid arthritis patients had a higher prevalence of metabolic syndrome.

Atherosclerosis

Rheumatoid arthritis patients have a higher prevalence of atherosclerosis than those without rheumatoid arthritis. Atherosclerosis and rheumatoid arthritis may share several pathogenic mechanisms, and systemic inflammation is likely among them. There may also be genetic processes involved. Autoimmune processes possibly play a role in both rheumatoid arthritis and atherosclerosis, too.

Serious Infections

Rheumatoid arthritis patients have been shown to have an increased risk of infection. According to one study, published in the September 2002 issue of Arthritis and Rheumatism, which assessed predictors of infection in rheumatoid arthritis, increased age, extra-articular manifestations of rheumatoid arthritis (i.e., factors other than joint involvement), comorbidities, and use of corticosteroids were strong predictors of infection. Interestingly, according to study results in the May 2013 Journal of Rheumatology the rate of serious infection in rheumatoid arthritis patients has declined in the past few years.

Gastrointestinal Perforation

Another potential cause of death related to rheumatoid arthritis is gastrointestinal perforation. It is uncommon, but a serious adverse event when it does occur. Patients being treated with glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDS) or who have a history of diverticulitis are at higher risk for gastrointestinal problems.

Sources:

Rheumatoid arthritis and cardiovascular disease. Dhawan SS et al. Current Atheroclerosis Reports. 2008 Apr;10(2):128-33.
http://www.ncbi.nlm.nih.gov/pubmed/18417067/

Rheumatoid Arthritis: Early Diagnosis and Treatment. Cush JJ et al. Third Edition. Professional Communications, Inc. Copyright 2010.

BMC Musculoskeletal Disorders: Metabolic Syndrome in Rheumatoid Arthritis: A case control study. Rosom S et. al. 4/26/13.
http://www.biomedcentral.com/1471-2474/14/147

Increased prevalence of metabolic syndrome associated with rheumatoid arthritis in patients without clinical cardiovascular disease. Crowson CS et al. Journal of Rheumatology January 2011.
http://www.ncbi.nlm.nih.gov/pubmed/20952464

Atherosclerosis and rheumatoid arthritis: more than a simple association. Cavagna l et al. Mediators of Inflammation. 2012;2012:147354. 9/13/2012.
http://www.ncbi.nlm.nih.gov/pubmed/23024462

Trends in serious infections in rheumatoid arthritis. Journal of Rheumatology. Ni Mhuircheartaigh et al. May 2013.
http://www.ncbi.nlm.nih.gov/pubmed/23547208

Predictors of infection in rheumatoid arthritis. Arthritis & Rheumatism. Doran MF et al. September 2002.
http://www.ncbi.nlm.nih.gov/pubmed/12355476

The incidence of gastrointestinal perforations among rheumatoid arthritis patients. Arthritis & Rheumatism. Curtis JR et al. February 2011.
http://www.ncbi.nlm.nih.gov/pubmed/20967860

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