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Widening Death Gap Haunts RA Patients

Over 50 Years, Rheumatoid Arthritis Patients See No Gain in Life Expectancy
By
WebMD Health News
Reviewed by Louise Chang, MD

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 ago.

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 average.

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 men.

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 other people.

"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."

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