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Rheumatoid Arthritis Death Rate Unchanged

Underlying inflammation may affect heart despite symptom relief, experts say

MONDAY, Oct. 29 (HealthDay News) -- Americans are likely to live longer than they did 40 years ago, but not if they have rheumatoid arthritis, according to a new study from the Mayo Clinic.

"When you look at persons with rheumatoid arthritis, they do not seem to have experienced the benefits over the last several decades of improved survival the rest of us have," said study co-author Dr. Sherine E. Gabriel, a professor of medicine and epidemiology at the Mayo Clinic in Rochester, Minn.

The findings, based on a large population sample of mostly white Minnesotans, showed that women and men diagnosed with rheumatoid arthritis between 1965 and 2000 died at a steady rate of 2.4 percent and 2.5 percent per year, respectively.

During the same period of time, annual death rates declined for men and women without rheumatoid arthritis. The rate fell from 1 percent per year for women in 1965 to 0.20 percent in 2000, and for men it dropped from 1.2 percent to 0.30 percent.

"This suggests that the dramatic changes in therapeutic strategies for rheumatoid arthritis in the last 4 to 5 decades have not had a major impact on excess mortality," the study authors said.

Looking further, they also extended the follow-up to 2007 on the sample of those diagnosed with rheumatoid arthritis between 1965 and 2000, hoping to pick up any downward trend in death rates resulting from the impact of the newest medications, Gabriel explained. Unfortunately, they found no such trend.

Still, a decline could show up if future studies with a longer look back at 2000 and later, when some of the most significant new medications were introduced, Gabriel and others say.

Rheumatoid arthritis is a chronic disease where the body mistakenly attacks its own tissues. It causes inflammation and painful joints, and also may attack other organs such as the heart. About 2.1 million Americans, or 1 percent of the population, have rheumatoid arthritis, according to the Arthritis Foundation.

Cardiovascular deaths accounted for about half of the deaths for rheumatoid arthritis patients in the research sample. The findings did not distinguish between the types of cardiovascular disease that led to mortality. An earlier Mayo study confirmed a strong link between rheumatoid arthritis and congestive heart failure, however.

"It is possible that the cardiovascular interventions that improved life expectancy in the general population may not have had the same beneficial effects in patients with rheumatoid arthritis," Gabriel said.

The research did not study the causes of mortality, added Gabriel. She speculates, however, that since inflammation is thought to be a risk factor for cardiovascular disease, patients with rheumatoid arthritis represent a higher risk group, because their illness involves active, systemic inflammation.

The study was expected be published in the November issue of the Journal of Arthritis & Rheumatism.

The results are a powerful reminder that rheumatoid arthritis is a "very important and deadly disease," said Dr. Hayes Wilson, a medical adviser to the Arthritis Foundation.

"It's not just 'take two aspirin and call me in the morning,' " he said. "Get an early diagnosis and treat it aggressively. The consequence of not treating it aggressively could be excess mortality," Wilson said.

"We need to find out why it's killing people," added Wilson, who is also chief of rheumatology at Piedmont Hospital in Atlanta.

Dr. Stephen Lindsey, chief of rheumatology at Ochsner Health Systems in Baton Rouge, La., noted that while the study does not cover the impact of the latest medications, other new drugs did become available in the '80s and '90s. However, they apparently did not improve mortality, he said.

"Even when we make [patients] hurt less, they still may be susceptible to other chronic diseases such as heart disease," he added.

Because of the relationship between inflammation and rheumatoid arthritis and inflammation and cardiovascular risk, that may mean that "no matter what we do, we can't lower their mortality rate," Lindsey said. However, until that's established, "We need to pay more attention to cardiovascular status early in the illness," he said. "We need to be on top of everything and not just on top of their pain and disability."

More information

There's more on rheumatoid arthritis at the Arthritis Foundation.

SOURCES: Sherine E. Gabriel, M.D., professor, medicine and epidemiology, Mayo Clinic, Rochester, Minn; Stephen Lindsey, M.D., chief, rheumatology, Ochsner Health Systems, Baton Rouge, La.; Hayes Wilson, M.D., chief, rheumatology, Piedmont Hospital, Atlanta, and medical adviser, Arthritis Foundation, Atlanta; November 2007, Journal of Arthritis & Rheumatism

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