Widening Death Gap Haunts RA Patients
Over 50 Years, Rheumatoid Arthritis Patients See No Gain in Life Expectancy
Oct. 29, 2007 -- Rheumatoid arthritis cuts years off people's lives -- and
despite treatment advances, patients die at the same rate they did 50 years
Over the same five decades, the general population has seen a big jump in
life expectancy. This means that the "mortality gap" continues to widen
for people with rheumatoid arthritis (RA), find Sherine E. Gabriel, MD, and
colleagues at the Mayo Clinic in Rochester, Minn.
Gabriel's team looked at death rates among residents of Olmstead County,
Minn., diagnosed with rheumatoid arthritis between 1955 and 2000. Their average
age was 57. The researchers followed up on the patients for nearly 12 years, on
Within 10 years of their rheumatoid arthritis diagnosis, 29% of those
diagnosed from 1995 to 2000 were dead. That's no better -- and a little worse
-- than the 24% death rate among those diagnosed from 1955 to 1964.
"The mortality rates are not that surprising -- it is known that people
with rheumatoid arthritis have higher-than-average mortality rates,"
Gabriel tells WebMD. "What is surprising is that when you look at these
mortality rates over a long period of time, they have not changed. Mortality in
the general population has improved, so over time the gap between this
particular subgroup and the rest of us has been widening."
How wide is this death gap? In Minnesota's general population, from 1965 to
2000 the death rate dropped fivefold in women and fourfold in men. No such gain
was seen in men or women with rheumatoid arthritis.
Here's another way to look at it. Compared to the general population, the
1965 death rate for rheumatoid arthritis patients was 2.4 times higher for
women and 2.5 times higher for men. By 2000, the death rate for rheumatoid
arthritis patients was 12 times higher for women and 8.3 times higher for
Rheumatoid Arthritis and Heart Disease
Most people with arthritis do not have rheumatoid arthritis. They suffer
from osteoarthritis, caused by wear and tear, injury, or aging. In rheumatoid
arthritis, damage occurs when the body's immune system attacks healthy tissues
in the joints. Although it can come at any age, rheumatoid arthritis most often
starts in middle age and worsens over time.
Why do rheumatoid arthritis patients die sooner than others do? Rheumatoid
arthritis doesn't just affect the joints. Gabriel, a rheumatologist, says
people with the disease have system-wide immune dysfunction, with very high
levels of inflammation.
While the study does not prove this is so, Gabriel speculates that heart
disease in people with rheumatoid arthritis is different from heart disease in
"I think cardiovascular disease is an important part of what is going on
here," she says. "And it is likely that this may be a bit different
from the cardiovascular disease the rest of us develop. It may be that
interventions to prevent and treat cardiovascular disease may be relatively
less effective for people with rheumatoid arthritis, and that is why they are
not experiencing the survival gains the rest of us have."