The Mortality Dragon: Do Rheumatoid Arthritis Patients Have to Die Early?
Reasons for the high mortality rate with Rheumatoid Arthritis
This is not a morbid post. If we’re going to fight a dragon, we need to know about the dragon. Why do Rheumatoid Arthritis patients have such a high mortality rate? Some of you have probably heard me speculate about mortality and RA in response to questions. Last year, I briefly examined what’s called the RA mortality gap. A few months ago, I found this 2 year old article called “Why do people with rheumatoid arthritis still die prematurely?” I pasted the link into my to-do list under these words: “This article agrees with me!”
Of course Professor Gabriel had no idea I agreed with her – it was just some shorthand for my eyes only – until today. You may recognize Dr. Gabriel’s name. She is the Mayo doctor who was quoted on the blog a couple weeks ago about the incidence of RA increasing in women. As a matter of fact, I just checked to be sure & yes, I quoted another study by Dr. Gabriel last year on the mortality gap. So what was so important this time? The article describes the three main reasons for the high mortality rate with RA.
In conclusion, three lines of evidence can explain why patients with RA die prematurely and why the mortality gap between RA and the general population appears to be widening. First, not only do patients with RA have a higher risk of multiple comorbid conditions but also they tend to experience worse outcomes after the occurrence of these comorbid illnesses. Second, patients with RA may not receive optimal primary or secondary preventive care. And third, the systemic inflammation and immune dysfunction associated with RA appears to promote and accelerate comorbidity and mortality. These findings indicate that effective, even optimal control of traditional risk factors alone, while important, will be insufficient to reduce the excess mortality in RA.
Summarizing the causes for excess mortality:
- Co-morbidities and worse outcomes (mainly cardiovascular disease).
- Less adequate preventive care.
- Systemic inflammation accelerates mortality.
You can read the whole article in the Annals of Rheumatic Diseases. Dr. Gabriel even calls for large randomized trials to specifically study how to eliminate premature death in RA patients. But I’d like to focus for a moment on our role as RA warriors against this disease and the years it can steal from us.
Fighting the high mortality of Rheumatoid Arthritis
Together, some warriors and I are reading the new book Laugh, Sing, Eat Like a Pig by e-Patient Dave deBronkart; “e-patient” stands for “empowered” patient. As Dave confronts cancer, he realizes, “If you live long enough to be killed by a bus, cancer didn’t kill you. HA!” Our goal is to become very wrinkled and gray and be hit by a bus.
What can we do? Now that we know what some reasons are for excess mortality, we can find ways to fight back.
- This is the reason I’m constantly telling RA’ers to keep asking until they get answers. Don’t accept symptoms as “just” RA – especially extra-articular symptoms. Of course RA may have been the cause, but it still may be able to be treated.
- Treat the Rheumatoid Arthritis aggressively and some studies show you may be treating the co-morbidities and inflammation as well.
- Get thorough preventative care. Here is an earlier article in the Journal of Rheumatology by Dr. Gabriel and others on the lack of preventive medical services for Rheumatoid Arthritis patients. We’ll talk more about preventive care with RA in the future.
Edit 2/20/2013: updated link to abstract document because pdf was no longer viewable without cost.
Edit 3/23/2013: updated another link for the same reason.
- Mortality and Rheumatoid Arthritis
- Problems with Preventive Care and Rheumatoid Arthritis Mortality
- Incidence of Rheumatoid Arthritis Increasing, in Women Especially
- Can Rheumatoid Arthritis Kill You?
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