Why Do People With Rheumatoid Arthritis Die?

Rheumatoid arthritis (RA) is not just a joint disease. It is a systemic illness which can kill. Studies have shown that RA has a significant mortality attached to it. Consider this: In the mid to late 1980's, a middle-aged man with RA could expect to have the same life expectancy as if he had non-Hodgkins lymphoma or triple-vessel coronary artery disease.

While these sobering statistics have changed somewhat for the better, the mortality picture for patients with RA is still not rosy.

Why does this increased mortality occur? Because it is a systemic disease, RA can lead to complications. One such complication is vasculitis (inflammation of blood vessels). In inflammation of blood vessels occurs in a major organ such as the brain or heart, a significant problem can occur. Inflammation of the eyes can lead to blindness. And RA involvement of the spine- particularly in the neck- can cause compression of the spinal cord. RA patients may develop significant lung disease with progressive interstitial problems leading to end-stage lung function.

Unfortunately, some of the medicines used to treat the symptoms of RA can also impair kidney function.

Patients with RA are also at increased risk for developing lymphoma.

The disability that occurs with poorly treated RA is in itself a cause of increased mortality.

The major discovery though has been the observation that RA patients are at markedly increased risk for developing significant early cardiovascular disease. Early cardiovascular mortality appears now to be the most significant factor leading to the shortened lifespan seen in patients with RA.

Why this occurs is still not clear. The major contributing factor appears to be the chronic inflammation associated with inadequately controlled RA. It is a subject of intense research now to see whether the more aggressive treatments that are being used will lower mortality by suppressing disease activity.

Patients with RA who have other cardiovascular risk factors such as elevated blood lipids, hypertension, cigarette smoking, etc. should be evaluated carefully. These other risk factors must be controlled or removed.