Friday, August 7, 2009

Mortality and Rheumatoid Arthritis


Is this the best time to have Rheumatoid Arthritis, Part 2: Quantity of Life

This is the second post in a series which addresses the question, “Is this the best time in history to have RA?” Yesterday, we looked at “quality” of life. Today we look at “quantity” of life, or longevity.

This might be depressing, so, I’ll try to make it brief. I have read some pretty ugly statistics about Rheumatoid Arthritis lately. And some of them are about life expectancy.

Mortality Gap

“Excess mortality” is consistently associated with Rheumatoid Arthritis. Some research shows that the mortality risk for RA-ers is about 38% greater than for the general population. It was even worse for women who have a 55% increased risk compared to women without Rheumatoid Arthritis. And no miracles of modern medicine have changed that.

In fact, when compared with the general population, the mortality gap has actually been widening. That’s right. Rheumatoid Arthritis patients are not experiencing the same improvements in survival rates as their peers without RA.

Mayo Clinic doctor Sherine E. Gabriel said this: "In fact, RA subjects did not even experience the same improvements in survival as their peers without arthritis, resulting in a worsening of the relative mortality in more recent years, and a widening of the mortality gap between RA subjects and the general population throughout time."

Reasons

At least half of deaths of those with Rheumatoid Arthritis are cardiovascular related. Although modern cardiovascular interventions have improved life expectancy for the general population, the same is not true for RA-ers. They say more research is needed to look for the reasons.

I do have some theories:
(1) Recent improvements in cardiovascular disease mortality are related to improved medication, diet, and advanced surgical procedures. Maybe RA-ers do not get cardiovascular disease for the same reasons that others do. So the treatments do not adequately tackle the heart disease of RA-ers.

I also wonder whether:
(2) The heart disease in RA-ers responds differently to those innovative treatments, or
(3) Heart disease in RA-ers is less treated because it is not diagnosed as frequently or as early.

How should we respond to the Mortality gap? Next time, in part 3, we look at how research can aim to make this a better time in history for those who do have Rheumatoid Arthritis.

Sources quoted:
medscape
About.com
Science Daily


3 comments:

Jenny said...

I wonder if the heart issues are related to the constant use of NSAIDs? I've been taking Celebrex since it first came on the market. Kinda scary and yes, depressing.

jamie said...

I wonder if the use of biologics and DMARDS as aggressively as they have been uses lately are part of this cause. It is now usually standard to attack RA aggressively at the early stages, but yet the mortality rate is no better, in fact worse??? Hm!!!

Kelly said...

Yea, we definately have not found the answer yet.
These studies look back over 40 years, so it's likely not the new drugs to blame.
Jenny: I am pretty sure that "regular" heart patients use NSAIDs a lot too.
Jamie: It's not that our mortality rate is worse; but that of the general population is improving and ours is not - so the gap widens.
It's eye-opening for me, because I never think of myself in terms of heart disease. Still have that childlike feeling: that could never happen to me.