Rheumatoid arthritis is a debilitating disease with serious physical, emotional, and economic consequences afflicting about 1% of the adult population of the world. The prevalence of the disease increases with age and affects two to three times as many women as men. The rheumatoid arthritis patient often faces:
- increasing functional disability
- likelihood of work disability within 10 years after the onset of the disease
- dramatic reduction in earnings
Compared to people without the disease, patients with rheumatoid arthritis will incur:
- higher medical care costs
- increased hospitalization
- greater numbers of physician visits
As in the general population, the leading cause of death among patients with rheumatoid arthritis is cardiovascular disease, and deaths due to malignancy occur at a comparable incidence. Patients with rheumatoid arthritis, however, are at greater risk of mortality due to:
- renal disease
- respiratory conditions
- gastrointestinal disease
Life expectancy is shorter among patients with rheumatoid arthritis than in the general population, and survival rates are comparable to those for Hodgkin's disease, diabetes mellitus, and three-vessel coronary artery disease.
Excess mortality from infection and from renal disease likely are indicative of the presence of severe disease, and most of the added mortality from gastrointestinal causes is treatment related. The bulk of renal problems in rheumatoid arthritis are related to complications such as vasculitis and amyloidosis, and complications to medical treatment of the disease with some of the main offenders being:
There is also increasing evidence that rheumatoid arthritis can cause subclinical renal dysfunction with microalbuminuria, as well as clinical disease caused by immune-complex mediated glomerulonephritis and interstitial tubular fibrosis.
Life Expectancy Studies
With regard to reduced life expectancy for rheumatoid arthritis patients, the standardized mortality ratio from different studies has ranged from 1.13 to 2.98. This mainly applies to rheumatoid factor positive cases, although a subgroup of rheumatoid factor negative cases with an adverse long-term prognosis exists. Clinically based studies probably overestimate the true shortening of life span and population-based studies may underestimate it.
In 1989, a study was done in Finland of 1666 people who had died and had been receiving medication for rheumatoid arthritis (RA). Demographic data on the Finnish population and sickness insurance statistics were used as the basis for computations. Results indicated that the life span of subjects with RA was shortened by 15-20% from the date of onset of illness.
- about 40% of the excess deaths were due to cardiovascular causes
- about 30% due to infections
- about 15% due to amyloidosis
- the remaining 15% were due to various other causes
Risks Vs. Benefits
It can be concluded that life expectancy is shortened for patients with rheumatoid arthritis. Treatment of the disease enhances quality of life. Generally, the benefits of treatment outweigh the risks, but that must be decided for individual patients and specific treatments, considering family history, overall health, and other treatment options.
- Rheumatoid Arthritis
- Rheumatoid Arthritis Treatments Do Not Increase Breast Cancer Risk
- Rheumatoid Arthritis Does Not Increase Lung Cancer Risk
Ugeskr Laegr 1996 May 27; 158(22): 3137-3140
Clin Exp Rheumatol 1995 Mar-Apr; 13(2): 149-53
Semin Arthritis Rheum 1995 Dec; 25(3): 193-202
Semin Arthritis Rheum 1991 Oct; 21(2 Suppl 1): 4-12