Complications and comorbidities of RA are the main contributors to a shorter life expectancy, although in some cases, the medications used to treat RA can contribute as well.
Cardiovascular Disease
RA increases your risk of cardiovascular disease. “While RA patients do not die from joint disease, their life expectancy is typically impacted due to an unexpected increased risk of cardiovascular disease (CAD) and heart attacks,” says Andrew Holman, MD, the CEO and cofounder of Inmedix, a medical diagnostics company in Normandy Park, Washington.
“RA patients also have higher daily sympathetic activity, also known as the “fight or flight” response, compared to those without RA. High activity levels of adrenaline are also considered an independent risk factor for CAD,” says Dr. Holman.
People with RA are also more likely to have heart disease risk factors, including:
- High blood pressure
- Obesity
- Metabolic syndrome, which is the combination of high blood pressure, high blood glucose, high triglycerides and LDL cholesterol, and obesity
- Abnormal lipid levels in the blood
- Smoking
Lung Disease
ILD is a collection of disorders associated with inflammation and scarring of the lung’s tissue and is one of the more serious complications associated with RA. It occurs when the overactive immune system starts to attack your lungs, leading to a buildup of scarring.
As the scarring increases, it can make it more difficult to breathe. In some cases, you may need a lung transplant to restore function in the lungs.
One study found that pulmonary complications are directly responsible for 10 to 20 percent of RA deaths. And another study found a strong association between RA-ILD and excess mortality, in particular respiratory and cancer mortality.
Researchers note that people with RA-ILD have a high risk of serious infection, especially respiratory infection, and that in this population, infection develops early, is recurrent, and is frequently fatal.
Infection
People with RA are more susceptible to infection, because of the autoimmune nature of the disease and the use of immunosuppressing or immunomodulating medications like glucocorticoids, biologics, and disease-modifying antirheumatic drugs (DMARDs).
Because the immune system is compromised, infectious disease can become serious enough to be fatal. One study found that people with RA have 2.2 times the risk of death due to infection compared with people without the condition.
Depression
Depression can be a factor in reducing life expectancy. While the research results need to be taken with caution, studies have shown that patients with RA who have comorbid depression have higher risk of mortality than non-depressed patients.
A large-scale meta-analysis of 268 studies found a twofold increased mortality risk in people with depression compared with control subjects; people with depression displayed 1.6-fold elevated risk of mortality from natural causes as well as a 9.9‐fold increased risk of suicide compared with people without depression. (Note: This meta-analysis involved people with depression, not necessarily RA.)
Cancer
Over the years, researchers have considered the use of biologics as a possible cause. But growing evidence suggests that RA increases the risk of cancer directly because of chronic inflammation.
Still, the increased risk of cancer remains relatively low for people with RA. For non-Hodgkin lymphoma, the most common type, the risk increases from 2 percent to 4 percent. While the increased risk is there and should be considered, the Arthritis Foundation describes it as modest.
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