The study followed 87,114 people with rheumatoid arthritis in Canada, with an average age of 57, and nearly 350,000 people age 15 and older from the general population from 2000 to 2013. During the study period, 14 percent of the people with rheumatoid arthritis and 9 percent of those in the general population group died. RELATED: Rheumatoid Arthritis Worsens Outlook After Heart Attack “We knew that [people with rheumatoid arthritis had] premature mortality, but previously there had not been large enough sample sizes in studies to see where the exact differences may be occurring,” says lead author Jessica Widdifield, PhD, of Sunnybrook Research Institute in Toronto, an adjunct scientist at the Institute for Clinical Evaluative Sciences and assistant professor at the Institute of Health Policy, Management, and Evaluation at the University of Toronto in Toronto.
A New Way of Looking at the Mortality Numbers
RA itself is not generally considered a lethal disease, and the rate of mortality attributed to it as the main underlying cause of death is on the decline. Deaths in people with RA had previously been seen as complications of RA and its treatment, so Widdifield and her team approached looking at RA mortality in a new way. They examined premature mortality and age at the time of death and the potential number of years of life lost. “That rate is double for people with RA,” says Widdifield. “This method puts more weight if you died at a younger age.” Of people with rheumatoid arthritis, 36 percent do not live to the age of 75, compared with 32 percent of people without the disease.
Cardiovascular and Respiratory Deaths in People With Rheumatoid Arthritis
While the causes of death were very similar among the two groups — the most frequent being circulatory system diseases, cancer, and respiratory infections — people with rheumatoid arthritis were more likely to succumb to those serious health problems at a younger age. RELATED: How to Protect Your Lungs When You Have Rheumatoid Arthritis “Our findings offer new insights into the importance of cardiovascular and respiratory contributions — including pneumonia — to shortening patient lives,” says Widdifield. Her analysis shows that a third of RA deaths can be chalked up to heart disease. “Both patients and physicians should be thinking about this connection earlier in the patient’s life. The heightened risk associated with respiratory diseases and respiratory infections should also be a cause for discussion,” she says.
Why Heart Disease Is More Deadly for Those With RA
Heart disease should be considered a serious cause for concern among people with RA, even those who’ve yet to reach middle age. The study authors found that people with RA under the age of 45 had almost a threefold increased risk of cardiovascular disease death compared with the general population, in large part because of the high-grade, systemic inflammation that goes along with RA. “It doesn’t only affect the joints, it’s throughout the body, and it attacks multiple organs,” says Widdifield. RELATED: How Rheumatoid Arthritis Progresses RA treatments themselves may also play a role in leading to premature death, particularly because they can leave people more susceptible to infections. “A lot of disease-modifying treatments have altering effects on the immune system, so people with RA should take mild infections seriously,” says Widdifield. “Talk to your doctor about the flu and shingles vaccines and about other preventive strategies. Even a mild infection can turn more deadly in [people with RA],” she says. RELATED: Why You Don’t Want to Get the Flu When You Have Rheumatoid Arthritis
Some Causes of Death Are Lower in People With Rheumatoid Arthritis
While the mortality rate was higher in people with RA for several serious health conditions — diseases of the circulatory system (29 percent in the general population vs. 30 percent with RA), cancers (26 percent vs. 33 percent), and respiratory diseases, including respiratory infections (12 percent vs. 9 percent) — people with RA were less likely to die from nervous system disorders, such as Alzheimer’s disease, and mental health disorders like dementia. And in other promising news, Widdifield says, mortality rates for people with RA are better than they were in previous decades. “That’s because of significant improvements in treatment for RA over the last decade,” she says. “Rheumatologists have better clinical practice. But the downside is that there aren’t enough rheumatologists in North America, and we have to be proactive about improving that.” RELATED: Rheumatoid Arthritis: What New Blood Pressure Guidelines Mean
