Rheumatoid arthritis (RA) can indirectly contribute to mortality, though it is rarely the direct cause of death. RA is a chronic, systemic inflammatory disease where the immune system mistakenly attacks the body’s tissues, primarily the joints. This chronic inflammation affects the entire body and leads to serious complications in major organ systems over time. The increased risk of death associated with RA stems almost entirely from these systemic effects. Managing the inflammation is a lifelong commitment aimed at preventing these life-threatening complications.
The Impact on Life Expectancy
Uncontrolled rheumatoid arthritis is associated with a shortened life expectancy compared to the general population. Recent data suggests an average loss of life expectancy of approximately five years for people with RA, though older studies reported losses as high as ten years. The reduction varies greatly depending on disease severity, the presence of other health conditions, and how well the inflammation is managed.
Historically, mortality rates for people with RA were significantly higher, with a risk of death about 1.5 times greater than those without the condition. Aggressive and early treatment strategies using modern medications have significantly improved these statistics. Studies focusing on individuals with recently diagnosed RA who receive intensive treatment have found that their mortality rates are approaching those of the general population. This positive trend underscores the importance of prompt diagnosis and sustained disease control.
Major Organ System Complications
The chronic inflammation defining RA drives life-threatening complications in other organ systems, primarily the heart and lungs. Cardiovascular disease (CVD) is the leading cause of premature death for people with RA, accounting for nearly 40% of their mortality. RA causes accelerated atherosclerosis, which is the faster buildup of plaque in the arteries.
This process increases the risk of heart attack, stroke, and heart failure, even independent of traditional risk factors like high cholesterol or smoking. The systemic inflammation directly damages the lining of the blood vessels, causing arterial stiffness and plaque that is more likely to rupture. People with RA are also twice as likely to develop heart failure compared to the general population.
Pulmonary disease is another major systemic complication, with respiratory issues being a frequent cause of death after CVD. Inflammation can directly affect the lungs, leading to conditions like interstitial lung disease (ILD). ILD causes progressive scarring of the lung tissue, which impairs the body’s ability to take in oxygen.
This lung scarring is a serious cause of morbidity and mortality; median survival for people with RA-associated ILD ranges from two to 14 years from diagnosis. Other pulmonary issues include pleural effusions (fluid accumulation around the lungs) and rheumatoid nodules in the lung tissue. The risk of death from respiratory complications can be up to six times higher in people with RA compared to those without the condition.
Inflammation, Treatment, and Infection Risks
The inflammatory nature of RA places individuals at a higher risk for serious infections compared to the general population. This vulnerability is compounded by the necessary use of immunosuppressive medications aimed at controlling the disease. Both disease activity and the use of certain treatments can impair the immune system’s ability to fight off pathogens.
Glucocorticoids, such as prednisone, have a dose-dependent effect on serious infection risk, meaning higher doses carry greater danger. Biological therapies and Janus kinase (JAK) inhibitors, while effective at controlling inflammation, also carry a small but significant increased risk of serious infections. These can include fatal infections like pneumonia and sepsis.
Beyond infections, unchecked systemic inflammation can cause other dangerous conditions, such as vasculitis (inflammation of blood vessel walls). Vasculitis can lead to damage in various organs, including the nerves, skin, and brain. In rare cases, chronic inflammation can also lead to secondary amyloidosis, where abnormal protein deposits accumulate in organs, potentially resulting in kidney failure.
Proactive Management to Reduce Mortality Risk
The most effective strategy for mitigating mortality risks associated with RA is achieving and maintaining low disease activity or remission. This is accomplished through strict adherence to disease-modifying antirheumatic drugs (DMARDs) and biologics prescribed by a specialist. By suppressing systemic inflammation, these treatments reduce the risk of accelerated atherosclerosis and organ damage.
Aggressive treatment aimed at low disease activity has been shown to normalize mortality rates in some patient cohorts. Controlling traditional cardiovascular risk factors is equally important, involving quitting smoking, managing blood pressure, and maintaining healthy cholesterol and blood sugar levels.
Regular screening for complications, such as lung function tests and cardiac assessments, allows for the early detection and management of organ system involvement. With modern medicine and a proactive approach, the risk of early mortality in RA can be significantly reduced.