Rheumatoid Arthritis Linked to Early Death

Oct. 15, 2002 -- rheumatoid arthritis increases the risk of premature death -- maybe to the same extent as having high blood pressure or heart disease -- a large study suggests. But experts say we're making headway toward treating the condition and preventing these early deaths.

Researchers found that elderly women with rheumatoid arthritis (RA) were much more likely to die during the study period than were elderly women without arthritis. And the risk of dying almost doubled in women who tested positive for rheumatoid factor -- an antibody present in roughly four out of five RA patients.

"rheumatoid arthritis is associated with an increase in mortality among women who get it later in life," lead researcher Ted R. Mikuls, MD, tells KB120. "What we don't know is whether we can have an impact on this mortality by treating these women more aggressively. That remains to be seen, but my hunch is that we can."

Approximately 2 million people in the U.S. have rheumatoid arthritis, according to the CDC. Women are two to three times more likely to develop the disease than men, and most people have symptoms early in life -- between age 20 and 45.

While at least 15 previous studies have shown a link between rheumatoid arthritis and early death, rheumatologist Daniel Solomon, MD, of Harvard Medical School's Brigham and Women's Hospital says there is emerging evidence that better treatments are improving the picture for RA patients.

"Older studies suggested a decrease in life span of about 10 years and newer studies suggest it is closer to five years," Solomon tells KB120. "We are doing a better job of recognizing and treating the [other illnesses] associated with RA, such as osteoporosis, infection, and [heart] disease. And we are also doing a better job of treating the underlying inflammatory condition, and not just the symptoms of RA."

In this study, published in the October issue of the journal Annals of Rheumatic Diseases, Mikuls and colleagues from the University of Alabama examined data on 31,000 postmenopausal women. None of the women had RA at the start of the study, but 158 women were eventually diagnosed. The average age of diagnosis was 68, and 60% of the women with RA tested positive for the rheumatoid factor antibody.

Even after adjusting for risk factors like smoking and being overweight, women with RA were 60% more likely to die during the follow-up period as were women without the disease. And those who were positive for rheumatoid factor were 90% more likely to die.

Women with RA were more than three times as likely to die of infection as those without the condition, and were slightly more likely to die of high blood pressure, heart disease, and other diseases of the circulatory system.

Mikuls says it is unclear how RA affects death, and he warns that the similar characteristics of the women in the study make it difficult to generalize the findings to other populations, such as men and minority women.

Now an assistant professor at the University of Nebraska, Mikuls says a major message from this study is that RA patients should be treated aggressively, regardless of their age. Solomon says there is some evidence that both patients and their doctors are getting that message.

"We now understand that RA is not just about having stiffness in the morning," he says. "It means having an increased risk of fractures, as well as heart attacks and infections. As rheumatologists, I think we are becoming smarter about understanding these [other illnesses] and how to protect patients from them." -->