Rheumatoid arthritis (RA) is both bothersome and painful. Less well known is the risk of premature death, because the disease can contribute to a less healthy lifestyle.
A study done using data from HUNT, the Trøndelag Health Study, shows that rheumatoid arthritis (RA) patients have a 23 per cent increased risk of dying prematurely.
The study compared the death rates among people with RA, people with diabetes and the rest of the population who participated in the Trøndelag Health Study (HUNT).
Diabetes carries an increased risk of cardiovascular disease and premature death. Rheumatoid arthritis also carries this risk.
Out of 67 221 people, 387 had arthritis, 2898 had diabetes and 33 people had both diagnoses. The participants were followed from the time they participated in HUNT2 (1995-97) or HUNT3 (2006-08) until the end of 2014. In addition, PhD candidate Ingrid Sæther Houge used data from the Norwegian Cause of Death Registry and hospital records.
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Compared to diabetes
“A lot of people think of rheumatoid arthritis as troublesome, but not dangerous. It’s well known that diabetes carries an increased risk of cardiovascular disease and premature death. RA also carries this risk,” says Houge.
A Danish study found that diabetic patients and rheumatoid arthritis patients both had a 70 per cent higher risk of heart attack compared with the normal population.
In Houge’s research study, RA patients had a 23 per cent higher risk of dying during the study period. Diabetic patients had a 56 percent higher risk of death.
“Our results suggest that it is less serious to have rheumatoid arthritis than diabetes in terms of death rates. But both diagnoses lead to higher mortality,” says Houge.
Not only joints affected
Rheumatoid arthritis is an autoimmune disease in which a person’s immune system attacks their own tissue. RA causes a lot of swelling, pain and stiffness in the joints. In addition, the disease increases the risk of cardiovascular disease, osteoporosis and inflammation of the blood vessels. People with RA thus have a shorter life expectancy.
“These results show how important it is to invest more in research and better treatment of arthritis. People with RA live longer today than 50 years ago, but the goal should be for them to live as long as the rest of the population,” says Houge.
It’s important to focus on lifestyle factors such as physical activity and quitting smoking.
Providing good drug treatment to reduce inflammation is key, along with preventive medical treatment of high blood pressure and high cholesterol levels.
“And it’s important to focus on lifestyle factors like physical activity and quitting smoking,” says Houge.
RA patients are less fit
People with rheumatoid arthritis are much less active than the rest of the population.
“A lot of patients who have chronic pain are often less active. Pain, stiffness, fatigue, which are common symptoms of the disease, clearly contribute to this,” says Houge.
Lots of disease factors can make it difficult to be active.
People with rheumatoid arthritis are less fit than their peers. Data from HUNT have shown that it is common for fitness levels to decrease with age. In RA patients, conditioning drops even more, according to a study by Marthe Halsan Liff, who is in the same research group as Houge.
“A lot of disease factors can make it difficult to be active,” says Houge.
She points out that intervention studies, where researchers introduce changes to uncover causal relationships for diseases, have shown that physical activity reduces fatigue and pain and is a good treatment for the symptoms of RA patients.
Less focus on joint protection
“People used to be really afraid that exercise would aggravate their ailments. Their strategy was to protect the joints by keeping them still. That approach has been completely abandoned now. But a lot of people still think that exercise might be dangerous,” Houge says.
Before, it was much more common for these patients to have major joint deformities.
One reason Houge wanted to study RA patients is that the patient group and the treatment of rheumatoid arthritis have changed a great deal over the last 20 years.
“It used to be much more common for these patients to have major joint deformities. Since the beginning of 2000, far fewer patients acquire deformities,” says Houge.
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Trying to beat back the disease
Major changes in drug treatment have occurred since the turn of the millennium. By starting earlier with higher medication doses, the current approach is to try to beat back the disease, according to Houge.
“To a certain extent, we’ve seen that this approach has contributed to a slight reduction in the risk of cardiovascular disease. But the risk is still higher than in the normal population,” says Houge.
She continues to research rheumatoid arthritis patients in her doctoral programme, and is now in the process of studying motivational factors that affect their activity habits.
Reference: Houge, I.S., Hoff, M., Thomas, R. et al. Mortality is increased in patients with rheumatoid arthritis or diabetes compared to the general population – the Nord-Trøndelag Health Study. Sci Rep 10, 3593 (2020). https://doi.org/10.1038/s41598-020-60621-2, https://ntnuopen.ntnu.no/ntnu-xmlui/handle/11250/2734994