RA Mortality/Morbidity | Arthritis Information

RA does not usually follow a benign course. It is associated with significant morbidity, disability, and mortality.

Daily living activities are impaired in most individuals with RA. Spontaneous clinical remission is uncommon (approximately 5-10%). After 5 years of disease, approximately 33% of patients are unable to work; after 10 years, approximately half have substantial functional disability. Poor prognostic factors include persistent synovitis, early erosive disease, extra-articular findings (including subcutaneous rheumatoid nodules), positive serum RF findings, family history of RA, male sex, and advanced age.

Life expectancy in patients with RA is shortened by 5-10 years, although the mortality rate may be lower in those who respond to therapy. Increased mortality rates are associated with poor functional status, age, male sex, socioeconomic factors (eg, level of education), positive RF findings, extra-articular disease, elevated acute-phase response (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and increased clinical severity (eg, more involved joints). Factors that increase the mortality risk include infections, cardiovascular disease, renal disease, GI bleeding, and lymphoproliferative disorders; these events may be directly due to the disease and its complications (eg, vasculitis, amyloidosis) or to therapy-induced adverse effects.

Effect of RA on organs and organ systems

Cutaneous: Subcutaneous nodules (rheumatoid nodules) develop in many patients with RA whose RF value is abnormal, often over pressure points (eg, olecranon). Vasculitic lesions of the skin may manifest as palpable purpura or skin ulceration.
Cardiac: Cardiovascular morbidity and mortality are increased in patients with RA. Nontraditional risk factors appear to play an important role. Myocardial infarction, myocardial dysfunction, and asymptomatic pericardial effusions are common; symptomatic pericarditis and constrictive pericarditis are rare. Myocarditis, coronary vasculitis, valvular disease, and conduction defects are occasionally observed.
Pulmonary: RA involvement of the lungs may take several forms, including pleural effusions, interstitial fibrosis, nodules (Caplan syndrome), and bronchiolitis obliterans-organizing pneumonia. Methotrexate (MTX) therapy can induce interstitial fibrosis that may be difficult to distinguish from that which naturally occurs in patients with RA.
GI: Intestinal involvement, as with kidney involvement, is often secondary to associated processes such as medication effects, inflammation, and other diseases. The liver is often affected in patients with Felty syndrome (ie, RA, splenomegaly, and neutropenia).
Renal: The kidneys are usually unaffected by RA directly. Secondary involvement is common, including that due to medications (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], gold, cyclosporin), inflammation (eg, amyloidosis), and associated diseases (eg, Sjögren syndrome with renal tubular abnormalities).
Vascular: Vasculitic lesions can occur in any organ but are most commonly found in the skin. Lesions may present as palpable purpura, skin ulcers, or digital infarcts.
Hematologic: Most active patients have an anemia of chronic disease. Several hematologic parameters parallel disease activity, including normochromic-normocytic anemia, thrombocytosis, and eosinophilia, although the latter is uncommon. Leukopenia is a finding in patients with Felty syndrome.
Neurologic: Nerve entrapment is common, such as with the median nerve in carpal tunnel syndrome. Vasculitic lesions, mononeuritis multiplex, and cervical myelopathy may cause serious neurologic consequences.
Ocular: Keratoconjunctivitis sicca is common in individuals with RA and is often the initial manifestation of secondary Sjögren syndrome. The eye may also have episcleritis, uveitis, and nodular scleritis that may lead to scleromalacia.

edited because I like the bold key

http://emedicine.medscape.com/article/331715-overview

Edited again because I forgot the link Metabolic Syndrome. When I was diagnosed I was 50 pounds overweight with lots of abdominal fat. My BP was elevated and my triglycerides were 350. Very low "good" cholesterol, glucose reading fell within prediabetic range -- scary, because my mother was diabetic. And then WHAM!, Ra, too.

Two years later I am a normal BMI - I lost 55 pounds, my BP is normal, triglycerides are 111, and cholesterol healthy. Glucose at last reading was 81. I quit smoking 2 years before being diagnosed, so at least I didn't have to overcome that hurdle. Getting myself back into shape was the hardest thing I've ever done in my life because I have NO willpower, but somehow I managed.

I don't think we should give in and become victims of this lousy disease and expect to die early; we must do everything in our power to contribute to our own well-being.

good for you Nancy[QUOTE=Nancy R.]I just read that Metabolic Syndrome increases (by 9 times) RA disease severity. That gave me a huge ray of hope, because I had Metabolic Syndrome. When I was diagnosed I was 50 pounds overweight with lots of abdominal fat. My BP was elevated and my triglycerides were 350. Very low "good" cholesterol, glucose reading fell within prediabetic range -- scary, because my mother was diabetic. And then WHAM!, Ra, too.

I don't think we should give in and become victims of this lousy disease and expect to die early; we must do everything in our power to contribute to our own well-being.

[/QUOTE]

I've never thougt of myself as a victim but I do think it's important for people to be aware of all the side effects that come with having RA.

Some you may have control over..others you may not, but it's always good to have knowledge My point is..... knowledge is power and that RA can be a very scary disease. It's not just a few aches and pains....People should be concerned and aware, especially about the cardiovascular risks associated with RA.

Edited because I left the "d" out of cardiovascular......

Lynn492009-04-04 16:11:33Nancy, you've done just about next to impossible......congratulations. Not everyone has the willpower, believe me I've been there. I've started to take responsibility for my weight and it's slowly working. Like Lynn, I've never been a victim of the disease, I've always been proactive in my treatment and healthcare.

Sandra, if you're husband started early treatment and is responding then his life expectancy will be within the normal range. The article didn't say ALL RA patients. I've had RA/PsA for about 24 years and only with a positive diagnosis for 15 of those years. During that time I developed pulmonary fibrosis and cardiac issues due to RA, so I probably fit into the current thinking regarding mortality. Now, with that being said I don't plan on having a shorter lifespan if it's within my control. I'm doing everything healthwise and lifestyle wise to make sure that I'm not one of the statistics. If you're not proactive then you will be a statistic. Lindy

Life expectancy in patients with RA is shortened by 5-10 years, although the mortality rate may be lower in those who respond to therapy. Increased mortality rates are associated with poor functional status, age, male sex, socioeconomic factors (eg, level of education), positive RF findings, extra-articular disease, elevated acute-phase response (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and increased clinical severity (eg, more involved joints). Factors that increase the mortality risk include infections, cardiovascular disease, renal disease, GI bleeding, and lymphoproliferative disorders; these events may be directly due to the disease and its complications (eg, vasculitis, amyloidosis) or to therapy-induced adverse effects.

Interesting read Knowledge is power it helps us to take control of our situations. Im not saying dont give us this information but maybe just the link so if there are are youngsters reading here they wont start to panic for no reason. My husband did not receive help early Lin ( long story that was posted a little while back) he has just responded well to the treatment he is currently on. DH belongs to an over 50's club for mobility challenged people. About 60% of its members have RA with no other illnesses related to this disease. 40% of them are in their 70's, have lived with RA when there was no treatment like my husband and others on here receive. A lot of them still play bowls, swim, play golf. Most of them still work one or two days a week.

There is no sure fire way of knowing what long term prognosis will be with something so fickle as RA . Keep healthy by eating well, take regular exercise, take the meds you are prescribed and live life to the full, its all anyone can do. If you spend too much time researching, worrying about death, looking for the bad things in life there wont be enough time for the good things.

Sandra, I should think that it is a better idea to see the article here and discuss it openly. That is what alleviates the fears for me, seeing what I can do to better my health, what others do and what has worked for them. It would seem to me youngsters should see exactly this type of discussion to see how to handle their disease and to be aware of the pitfalls of complacencies with RA.

If Lynn just publishes the link, won't they just follow it and read it anyway? Then they may miss out completely on the discussion... total freak out in the making.
[QUOTE=Sandra]Knowledge is power it helps us to take control of our situations. Im not saying dont give us this information but maybe just the link so if there are are youngsters reading here they wont start to panic for no reason.[/QUOTE]

Quite often, links are only good for a few months - and sometimes even much less than that. I think it is important to provide the article as well as the link.
Bumping for the newbies..Watch it to the end!

http://www.youtube.com/watch?v=qSm2llQLCH4

Love the video!Glad you liked it MJ. It's a Woody Allen movie, how could it be bad?

It's my theory of life! None of us know when our time is up, so rather than worrying about when I will die, I prefer to embrace life now.