Among doctors caring for patients with rheumatoid arthritis, it is well known that the disease which when active makes life a living hell affects not only the joints, but the entire body. RA is a systemic inflammatory disease, and suppressing its activity is a difficult but necessary program, often involving numerous powerful drugs. In the U.S., there are about one and a half million RA patients; the disease is more common in women, and most often strikes in the prime of life, but there are variants that attack young children as well.
Active RA shortens life expectancy significantly due to a variety of reasons, including vascular diseases (mainly coronary heart disease), infections, and other medication-related complications. The most cited studies have found a reduction in life expectancy among RA patients of about 5 years compared to the general population, but others have found even worse prognoses of up to 10 years shorter life. The key to such predictions is the age of onset the earlier the onset, the worse the long-term picture and the degree of activity.
A new study out of the UK has shown a significant improvement in lifespan among RA patients as compared to the studies of 25 years ago. The Early RA Study (ERAS) collected data from 1986 through 1998; the current study, the Early RA Network (ERAN), did the same between 2002 and 2012. The study, presented at the annual meeting of the British Society for Rheumatology, was led by Sam Norton, PhD, of King s College, London, and colleagues. The earlier study consisted of 1,500 patients, the latter 1200 patients. The average age at death increased from 76.7 years to 86.7 among the later group, and there was a 27 percent decrease in excess mortality. But complicating this picture, the age of onset was 53, on average, in the ERAS study and 57 in ERAN, and the disease was somewhat more active on enrollment in the earlier group as well. Two-thirds of both groups were female, and none of them were on immunosuppressive therapy at enrollment.
ACSH s Dr. Gil Ross, who practiced rheumatology along with internal medicine in the 20th century, had this perspective: This is indeed gratifying news. It s bad enough to deal with active RA without worrying about dying prematurely. According to these data, life expectancy among RA patients in the recent study was pretty much equivalent to non-RA patients. I am certain, although the details are lacking from this meeting presentation, that the lifespan is closely related to keeping disease activity in check, and the newer disease-modifying agents, including biologicals and immunosuppressives, are much more effective at this than the methods I had at my disposal twenty or more years ago, thankfully.