Patients with rheumatoid arthritis (RA) know they face a higher risk of premature death as well as serious complications that come along with their ailment.
In addition to increased mortality rates, RA patients continue to struggle with a poorer heart health along with their condition.
One new study presents yet more dismal news on this front. Fortunately, another offers some hope.
According to a study of nurses’ health by Brigham and Women’s Hospital (BWH), patients with RA have a significantly elevated risk of death, typically from disease complications related to cardiovascular or respiratory problems.
The results were based on 964 female nurses followed from 1976 to today and comparing them to the rest of the nurses in the study who didn’t have RA. In all, data from more than 100,000 nurses was included in the study.
Studies Break New Ground
A spokesman for the BWH research said the findings were eye-opening because previous studies had indicated there tended to be respiratory or cardiovascular problems in RA patients, but they could not pinpoint a cause.
“Previous studies have suggested that RA may be associated with increased mortality, but were not able to control for other variables, such as smoking, that affect both RA and mortality risks,” said corresponding author Dr. Jeffrey Sparks of the BWH Division of Rheumatology. “Because the Nurses’ Health Study is so large and has been following participants for so long, we were able to gather much more information about our subjects. We could follow them before and after diagnosis, take their health behaviors into account and determine specific causes of death. By doing so, we found strong evidence of increased risk for respiratory, cardiovascular, and overall mortality for patients with RA.”
He added they adjusted the statistics to take into account for other factors such as smoking to hone in on causes related solely to RA.
But, the news isn’t all bad.
Another study by the Mayo Clinic shows that RA deaths from cardiovascular causes are slowly going down. The results were released at the annual American College of Rheumatology meeting.
This is thanks in part to better drugs as well as doctors encouraging health and lifestyle changes in patients with RA. Efforts to prevent heart disease and to detect and treat it early are also paying off, researchers said.
RA patients continue to face heart disease at a rate two times that of the general population, but the fact they are dying from it less often is encouraging to many.
"More research is needed to confirm why heart disease deaths among rheumatoid arthritis patients have declined, but potential factors include earlier and more vigilant screening for heart problems, improved treatment for heart disease and rheumatoid arthritis, and in general, more attention to heart health in patients with rheumatoid arthritis,” said Dr. Elena Myasoedova, Ph.D., a Mayo Clinic rheumatologist who was the lead author on the study.
During the Mayo Clinic study, researchers looked at heart disease deaths within 10 years of RA diagnosis among two groups. One group was made up of 315 patients diagnosed with RA between 2000 and 2007. The other group was comprised of 498 patients diagnosed with RA in the 1980s and 1990s.
Researchers also looked at heart disease deaths among 813 people without a rheumatic disease. Approximately two-thirds of patients in the study were female, with an average age of 60.
A significantly lower rate of deaths from heart disease was found in the more recently diagnosed RA patients than in those diagnosed in previous years. The respective death rates of these two groups were 2.8 percent and 7.9 percent.
The study also considered deaths of RA patients resulting specifically from coronary artery disease. Those death rates also went down in the 10 years after the patients studied were diagnosed with RA.
Differing Views from Patients
RA patients cope with concerns about death in different ways and have different outlooks on it, despite fighting the same disease.
“Mortality doesn't cause me as much anxiety as immobility. Life with or without RA is not guaranteed so I try to live every day to the fullest and without regrets,” said Elaine Wiley of California. “I think the fear of disease progression to the point of losing mobility drives me to push myself more daily even with pain because of the reality of not being able to in the future.”
Kirsten Schultz, an RA patient from Wisconsin, has a slightly different view.
“The mortality rates associated with rheumatic diseases and common comorbidities are startling,” she said. “I grew up with juvenile arthritis and knew from a young age that I would likely not live as long. On one hand, it's pushed me to do some cool things and create great memories because I know we aren't promised tomorrow. On the other hand, it feeds my depression and anxiety immensely. I would be lying if I said death wasn’t the thing I'm most afraid of.”