MedWire News: Coronary heart disease remains largely unrecognized as a cause for death in patients with rheumatoid arthritis (RA), results from a long-term study of autopsy data indicate.
"Very few RA mortality series examine changes in specific causes of death over time," explain Riitta Koivuniemi (Helsinki University Central Hospital, Finland) and colleagues.
Indeed, previous studies into the cause for death in patients with RA have contradicted each other and have been based on clinical diagnosis, rather than autopsy data, and so may be unreliable.
For their study, Koivuniemi and co-researchers looked at data concerning the causes for death for 369 individuals with RA, produced by clinicians and pathologists before the autopsy. These data, collected over a period of up to 40 years, were then compared with similar data for 370 individuals without RA.
As expected, autopsy-determined cause of death in RA patients was usually RA itself, cardiovascular disease, or infection.
Of note, however, agreement about cause of death between clinicians and pathologists was lower in patients who had had RA than in those who had not.
Death of RA patients from gastrointestinal disease was most commonly misdiagnosed by clinicians.
The exception to the rule was in patients with RA treated with disease-modifying anti-rheumatic drugs, for whom cause of death was usually the same when given by a clinician or a pathologist.
Notably, the number of deaths caused by coronary heart disease significantly decreased after the 1970s in those individuals without RA while it did not change in those with RA.
"Our results indicate that RA patients may suffer from silent coronary heart disease," the authors write in the journal Rheumatology International.
"An active search for coronary heart disease and its effective treatment, with its risk factors-including active RA-is important to reduce cardiovascular mortality in RA," the investigators add.
Yes, that's an important observation Marian. Elevated CRP can be a "harbinger" of coronary artery disease and it's important to know that the inflammation caused by R/A can cause problems within the cardiovascular system. After 15 years of R/A I had a heart bypass. My cardiologist attributed problems in my left anterior descending artery to inflammation caused by R/A. Like many people I had never bothered to check my heart status with a competent cardiologist. A few bucks spent on a proper cardiovascular check is worth your life. And yes, smoking is out, exercize is in, and trying to stay stress-free (if you can) are crucial in helping manage the incidence and effects of inflammation in R/A.
Food for thought...Moving this back up