Although rheumatoid arthritis (RA) is not a fatal disease, it is associated with health complications such as lung and cardiovascular disease. These complications may raise mortality rates and lower life expectancy. Fortunately, management strategies can lessen the risk of RA complications and promote overall health.
Life expectancy is impacted by several genetic, environmental, and lifestyle factors. Although many people with RA live long lives, studies demonstrate that the condition can shorten life expectancy by an average of 10 years compared to the general population. Additional research is needed to understand the reasons behind this shortened life span. However, several indicators are linked to reduced life expectancy, including:
Smoking also increases the risk of death in those with RA. One study found that, over five years, smokers’ death rates were nearly twice that of nonsmokers. Heart disease was the leading cause of death in this study. However, the effect of smoking on death risk falls significantly once a person quits.
Fortunately, earlier diagnoses and newer treatments have lessened the impact of RA on life span. A recent study found declining death rates over a 15 year period in individuals with RA.
Although these comorbidities are associated with a decreased life span, close medical monitoring and treatment can help those with RA manage their risk.
People with RA are at a higher risk for heart and other cardiovascular diseases. People with RA are nearly twice as likely to develop heart disease, and heart disease accounts for almost a third of deaths in those with RA. Studies show that death from heart disease occurs, on average, 10 years earlier in people with RA compared to the general population.
RA increases the risk of ischaemic heart disease, a condition where the blood vessels become blocked, limiting blood flow and oxygen reaching the heart. Several factors may underlie the increased risk of cardiovascular diseases, including:
People with RA are also more likely to develop high blood pressure and high cholesterol. Together, these risk factors increase the chance of heart attack, heart failure, and stroke.
Read more about RA and heart disease.
Lung problems linked with RA include:
In RA, the scarring associated with ILD is caused when the body's overactive immune system attacks the lungs. Some RA medications, such as methotrexate and tumor necrosis factor (TNF) inhibitors, are also linked to ILD. Over time, excessive scarring leads to breathing difficulties. Nearly 10 percent of those with RA develop ILD at some point during their disease, and some may need lung transplants.
Read more about RA and lung disease.
People with RA are more likely to develop certain types of cancer, including lung cancer and lymphoma. The risk of lymphoma — a cancer of the lymphatic system, part of the circulatory and immune systems — is double in those with RA than in the general population. Cancer risk is highest in those with high disease activity and those undergoing aggressive treatment.
Although additional research is needed, the altered function of the immune system seen in RA may decrease the body’s ability to fight cancer. Also, many RA medications work through anti-inflammatory mechanisms by turning down the immune response. Although effective for treating RA, these medications may also limit the body’s anti-cancer pathways.
Although most infections in people with RA are easily treatable, serious infections can occur. Some RA medications, such as Azasan (azathioprine), Cytoxan (cyclophosphamide), and corticosteroids, can increase the risk of infections due to their impacts on the immune system. Biologic therapies, including TNF inhibitors, are associated with an increased risk of serious infections, such as tuberculosis (TB) in those who have been previously exposed to TB.
Seeking early and regular care with a rheumatologist can help those with RA successfully manage their disease and limit health complications. Studies show that sustained control of RA disease activity improves both quality and length of life.
Both you and your doctor should be on the lookout for new or worsening symptoms that may indicate an underlying health condition, such as:
Additional medical screening may be needed to test for other health problems. Regular blood pressure and cholesterol screens are often used to monitor for cardiovascular disease.
Early diagnosis and treatment with RA medications, including disease-modifying antirheumatic drugs (DMARDs) and biologics, can help slow disease progression. In addition to using medications, those with RA can follow self-management strategies to limit the risk of other health conditions.
Strategies to increase both quality of life and life span in those with RA include:
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