How to Manage Rheumatoid Arthritis Mortality Risks
Following Glenn Frey’s death from complications of RA, there was a lot of conversation about the seriousness of rheumatoid arthritis (RA). To put it bluntly, we talked about the fact that RA can kill you.
And it was a welcome conversation. It helped change the public perception of RA as something with a bit of joint pain. It also brought awareness to many people who live with the disease and their loved ones who were previously aware of how serious RA can be.
It also made a lot of us very anxious.
One of the people weighing in about this issue was rheumatologist Dr. Jack Kush. He wrote an excellent article outlining the many ways in which this disease is a serious one. It is incredibly useful information, but it is also very scary. I’m sure not the only one who read these kinds of articles through my fingers while clutching a teddy bear. It is difficult to face your mortality.
To help you deal with the fear, here are some ways you can manage the risks.
The mortality gap
Historically, people living with RA have had a shorter life expectancy than the general population. It’s called the mortality gap. This is especially so for women, people with uncontrolled RA, and those who have seropositive RA. Short of getting gender assignment surgery, there’s not much you can do about being a woman, but you can do something about treating your RA. Work with your rheumatologist to find a way to suppress your disease. Unfortunately, some do not respond to the medications currently on the market, but even somewhat lowered disease activity will reduce your risk.
As someone who lives with RA, you are at a higher risk for developing infections, in particular pneumonia. In fact, pneumonia is the leading cause of death from infection in people with RA. Get the pneumonia vaccine, and while you are at it, make sure you get the flu shot and a tetanus shot. Protect yourself from infection whenever you can. This includes paying attention to your skin, and seeking medical care if a wound gets red and irritated, or is slow in healing. If you have surgery, talk to your doctor about how to manage the risk of infection.
Lymphoma and cancer
RA brings with it an increased rate of certain kinds of cancer (non-Hodgkin’s lymphoma, lung and skin cancer), yet paradoxically a lower risk of breast and colon cancer. At least there is some good news! Adapt your lifestyle to reduce risk factors, such as quitting smoking, and being careful in the sun. According to Dr. Cush’s article, high disease activity is associated with a much higher risk of non-Hodgkin’s lymphoma. Work with your doctor to get your disease treated early and aggressively.
RA is a systemic disease. This means the inflammation affects the joints, as well as other systems in your body, such as your organs and vascular system. These are called extra-articular, or systemic manifestations. RA inflammation can cause kidney disease, cardiovascular disease (see below), vasculitis, and several other conditions. All of these can be very serious. The best way to reduce the risk is to get your disease treated. As well, make sure you and your doctors have conversations about how to manage the systemic effects of RA. This includes starting preventative care earlier than your contemporaries.
Heart disease and stroke are the big factors in the above-mentioned mortality gap. Inflammation is very much a part of what causes cardiovascular disease, including heart attacks. Talk to your doctor about managing the risks. Eat a balanced diet, exercise as much as you can, and don’t smoke. As well, starting preventative heart care—such as stress tests—about a decade or more before the general population does can help you manage this risk.
Chronic lung disease, such as interstitial lung disease, affects especially men, those who are diagnosed later in life, and those who have very active diseases. Again, getting your RA under control plays a significant role in managing the risk. Keeping your lungs healthy is also important. Make sure you get the pneumonia vaccine, as the scarring from pneumonia can contribute to lung problems.
Environmental factors play a significant role in both the development and the ongoing disease. This is one area where you have a lot of control over the risk factors. If you smoke, quit. If you’re overweight, lose as much of the weight as you can. Develop a good relationship with your dentist so your teeth are healthy and free of periodontal disease. Eat a healthy diet (I can't reiterate this enough).
Being aware of the very serious aspects of RA – by which I mean the ones that can kill you — is important. As much as you may want to stick your head in the sand, be brave and face them head-on. Knowing these risks means that you and your doctors can take steps to manage them. It is one of the ways that you can take back control of your life and it’s the key to beating back the fear.
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Lene writes the award-winning blog The Seated View. She’s the author ofYour Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.