A new British study shows that people with rheumatoid arthritis (RA) are living longer than ever before. A comparison of data from 1986-1998 to 2002-2012 shows that people with RA were, on average, experiencing a 10-year increase in life expectancy.
A previous study by Humphreys, et al, through The Norfolk Arthritis Register, using data specific to the Norfolk region, showed that mortality rates had not changed substantially in over 20 years. One of the hard truths about rheumatoid arthritis is that people who have the disease have a shorter life expectancy. It’s called the mortality gap. RA is a systemic disease - the inflammation doesn’t just affect joints, but also other systems in the body, including the heart. This results in people with RA having an increased risk of heart attack and stroke compared to the rest of the population. In the past, the mortality gap was estimated to be 10 years, meaning that people with RA on average died 10 years before people who did not have RA.
Sam Norton, PhD at King’s College, London, conducted a study to examine national UK trends regarding mortality in people living with RA. Norton used 2002-2012 data from the Early Rheumatoid Arthritis Network (ERAN), a network of British departments of rheumatology collecting the details on early RA patients to assess long-term outcomes on a national level. Norton compared the data to the 1986-1999 Early Rheumatoid Arthritis Study (ERAS) and discovered that people with RA were, on average, living 10 years longer (age of death 86.7 versus the previous 76.7) than those without RA.
There were a number of possible explanations for the results. Overall mortality had decreased by 27 percent, seen primarily in the part of the RA population that was younger than 55. The incidence of death due to cardiovascular events had also decreased. In addition, age of onset had increased by five years, from 54.2 in 1986 to 58.5 in 2012, meaning that people had lived longer without the inflammation of RA affecting their system.
The difference between the study conducted by Humphreys of the Norfolk region and the study by Norton is interesting. One utilizes data from a particular region of the UK, whereas the other uses national UK data. The difference is, as of yet, unexplained. Until a full write-up the Norton study is published, it will remain unaddressed. It’s likely that more research into life expectancy and RA will be necessary to shed further clarity on the subject.
Living Longer with RA
One significant possible factor for the increased life expectancy not mentioned in the overview of Norton’s presentation is treatment. The overview specified that none had taken disease modifying antirheumatic drugs (DMARDs) at the time of enrollment in ERAS and ERAN. However, despite some differences between North American and UK treatment modalities, it’s most likely a safe assumption that people under the care of the UK rheumatologist would receive treatment to control their RA.
Within a year of the 1998 conclusion of ERAS, medications became available that led to a dramatic increase in remission and a much lower disease activity than before. Immunosuppressants such as methotrexate and the biologics have had a profound impact on the ability to control the inflammation that leads to disability and increased mortality rates. In fact, one study demonstrated that the longer a person takes anti-TNF medications, the lower the risk of heart disease. Suppressing inflammation, whether by anti-TNF or other drugs, is an essential component in protecting your joints and your heart.
In addition to treating your disease, there are a number of day-to-day techniques you can use to protect your heart health. Physical activity is key, but can be a challenge depending on your level of disease activity and chronic pain. There are a number of ways to remain physically active with different levels of RA, including range-of-motion exercises, yoga or tai chi, as well as more intense activity. Ask your doctor for a referral to a physical therapist to help you stay active without straining your joints.
Eating a balanced diet, rich in fruits and vegetables and omega-3 fatty acids from fish oil and fatty fish, such as salmon and tuna, is also good for your heart. So is flossing, believe it or not Flossing regularly isn’t just good for your teeth, but may also protect your heart. Researchers theorize that bacteria from your mouth can enter the bloodstream, contributing to inflammation. Keeping your mouth clean can protect the rest of your body. Lastly, quitting smoking will add years to your life. If you need help to quit, talk to your family doctor.
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.