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Senior Citizen Health & Medicine
Mortality Gap Widens with Rheumatoid Arthritis, No
Longevity Increase in Decades
Mayo Clinic study says action needed. Most senior
citizens have rheumatoid or other forms of arthritis
 Oct. 29, 2007 – Rheumatoid arthritis (RA), an
autoimmune inflammatory disease that takes a progressive toll on the
heart, kidney and liver as well as the joints, is a diagnosis that
carries a high risk of early death. This sobering fact is well known.
Less is known about whether longevity has improved for RA patients over
the past few decades of remarkable improvements in longevity in the
general population.
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Health & Medicine |
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Are earlier diagnosis, breakthrough drugs, and more
aggressive antirheumatic treatment regimens paying off in terms of
survival?
For answers to this vital question, researchers at
the Mayo Clinic conducted a sweeping comparison of mortality trends
among RA subjects with those in the general population.
Their unsettling results, presented in the November
2007 issue of Arthritis & Rheumatism underscore the urgent need to find
strategies that will work to reduce the excess mortality consistently
associated with RA, they say.
Millions of adults and half of all people age 65
and older are troubled by some form of arthritis, according to the
National Institute on Aging. Senior citizens most often have
osteoarthritis, rheumatoid arthritis, or gout.
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What is Rheumatoid Arthritis (RA)? |
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Rheumatoid
arthritis (RA) is a form of arthritis that causes pain, swelling,
stiffness and loss of function in your joints. It can affect any joint
but is common in the wrist and fingers.
More women than men get
rheumatoid arthritis. It often starts between ages 25 and 55.
You might
have the disease for only a short time, or symptoms might come and go.
The severe form can last a lifetime.
Rheumatoid arthritis is different from
osteoarthritis, the common arthritis that often comes with older
age. RA can affect body parts besides joints, such as your eyes, mouth
and lungs.
RA is an
autoimmune disease, which means the arthritis results from your
immune system attacking your body's own tissues.
No one knows what causes rheumatoid arthritis.
Genes, environment and hormones might contribute.
Treatments include
medicine, lifestyle changes and surgery. These can slow or stop joint
damage and reduce pain and swelling.
National Institute of Arthritis and Musculoskeletal
and Skin Diseases
>>
Click to more information
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Drawn from the comprehensive medical records of all
residents of Olmsted County, Minnesota, 822 RA subjects were identified.
The subjects included all residents of Rochester, Minnesota, first
diagnosed with RA between January 1, 1955, and January 1, 1995, as well
as all Olmsted County residents diagnosed with RA between January 1,
1995, and January 1, 2000.
The subjects were 71.5 percent women, with a mean
age of 57.6 years at RA incidence. All were followed up through their
entire medical records until death or January 1, 2007. The median time
of follow-up was 11.7 years, during which 445 of the RA subjects died.
Researchers compared the survival rates of patients
diagnosed with RA in 5 time periods: 1955-1964, 1965-1974, 1975-1984,
1985-1994, and 1995-2000 using Cox regression models, adjusting for age
and sex.
In the 5 time periods, there was no significant
difference in survival rates for RA subjects - which also means no
significant gains in longevity.
To confirm their findings, researchers calculated
and compared mortality rates using person-year methods. Based on the
National Center for Health Statistics life tables for the Minnesota
white population, researchers also determined the number of expected
deaths for people of similar age and sex in the general population.
Between 1965 and 2005, the mortality rates for
female and male RA subjects were relatively constant at 2.4 and 2.5 per
100 person-years, respectively. In contrast, the expected mortality rate
decreased substantially for both female and male subjects from the
general population over the same time period.
Mortality in women in the
Minnesota general population declined from 1.0 per 100 person-years in
1965 to 0.2 per 100 person-years in 2000. Similarly, mortality in men
decreased from 1.2 per 100 person-years in 1965 to 0.3 per 100
person-years in 2000.
“We found no evidence indicating that RA subjects
experienced improvements in survival over the last 4-5 decades” states
the study’s leading author, Dr. Sherine Gabriel.
“In fact, RA subjects did not even experience the
same improvements in survival as their peers without arthritis,
resulting in a worsening of the relative mortality in more recent years,
and a widening of the mortality gap between RA subjects and the general
population throughout time.”
While the study’s findings focused almost
exclusively on white individuals in one geographic area, they raise
general concerns about current intervention strategies for RA.
“Although the reasons for the widening mortality
gap are unclear,” Dr. Gabriel notes, “cardiovascular deaths constitute
at least half of the deaths in subjects with RA, and it is possible that
the cardiovascular interventions that improved life expectancy in the
general population may not have had the same beneficial effects in
persons with RA.”
She stresses the urgent need for research aimed at
fully understanding this alarming trend and finding solutions that will
close the mortality gap for more people with RA.
Source
Article: “The Widening Mortality Gap Between
Rheumatoid Arthritis Subjects and the General Population,” Angel
Gonzalez, Hilal Maradit Kremers, Cynthia S. Crowson, Paulo J. Nicola,
John M. Davis, III, Terry M. Therneau, Veronique L. Roger, and Sherine
E. Gabriel, Arthritis & Rheumatism, November 2007; (DOI:
10.1002/art.22979). -
Arthritis & Rheumatism
Arthritis Advice from National Institute on Aging
“Arthritis” is not just a word doctors use when
they talk about painful, stiff joints. In fact, there are many kinds of
arthritis, each with different symptoms and treatments. Most types of
arthritis are chronic. That means they can go on for a long period of
time.
Arthritis can attack joints in almost any part of
the body. Some forms of arthritis cause changes you can see and
feel—swelling, warmth, and redness in your joints. In some the pain and
swelling last only a short time, but are very bad. Other types cause
less troublesome symptoms, but still slowly damage your joints.
Common Kinds of Arthritis
Arthritis is one of the most common diseases in
this country. Millions of adults and half of all people age 65 and older
are troubled by this disease. Older people most often have
osteoarthritis, rheumatoid arthritis, or gout.
Osteoarthritis (OA) is the most common type of
arthritis in older people.
OA starts when cartilage begins to become
ragged and wears away. Cartilage is the tissue that pads bones in a
joint. At OA’s worst, all of the cartilage in a joint wears away,
leaving bones that rub against each other. You are most likely to have
OA in your hands, neck, lower back, or the large weight-bearing joints
of your body, such as knees and hips.
OA symptoms can range from stiffness and mild pain
that comes and goes with activities like walking, bending, or stooping
to severe joint pain that keeps on even when you rest or try to sleep.
Sometimes OA causes your joints to feel stiff when you haven’t moved
them in a while, like after riding in the car. But the stiffness goes
away when you move the joint. In time OA can also cause problems moving
joints and sometimes disability if your back, knees, or hips are
affected.
What causes OA? Growing older is what most often
puts you at risk for OA.
Other than that, scientists think the cause
depends on which part of the body is involved. For example, OA in the
hands or hips may run in families. OA in the knees can be linked with
being overweight. Injuries or overuse may cause OA in joints such as
knees, hips, or hands.
Rheumatoid Arthritis (RA) is an autoimmune disease.
In RA, that means your body attacks the lining of a joint just as it
would if it were trying to protect you from injury or disease. For
example, if you had a splinter in your finger, the finger would become
inflamed—painful, red, and swollen. RA leads to inflammation in your
joints. This inflammation causes pain, swelling, and stiffness that
lasts for hours. This can often happen in many different joints at the
same time. You might not even be able to move the joint. People with RA
often don’t feel well. They may be tired or run a fever. People of any
age can develop RA, and it is more common in women.
RA can attack almost any joint in the body,
including the joints in the fingers, wrists, shoulders, elbows, hips,
knees, ankles, feet, and neck. If you have RA in a joint on one side of
the body, the same joint on the other side of your body will probably
have RA also. RA not only destroys joints. It can also attack organs
such as the heart, muscles, blood vessels, nervous system, and eyes.
Gout is one of the most painful forms of arthritis.
An attack can begin when crystals of uric acid form in the connective
tissue and/or joint spaces. These deposits lead to swelling, redness,
heat, pain, and stiffness in the joint. Gout attacks often follow eating
foods like shellfish, liver, dried beans, peas, anchovies, or gravy.
Using alcohol, being overweight, and certain medications may also make
gout worse. In older people, some blood pressure medicines can also
increase your chance of a gout attack.
Gout is most often a problem in the big toe, but it
can affect other joints, including your ankle, elbow, knee, wrist, hand,
or other toes. Swelling may cause the skin to pull tightly around the
joint and make the area red or purple and very tender. Your doctor might
suggest blood tests and x-rays. He or she might also take a sample of
fluid from your joint while you are having an attack.
Other forms of arthritis include psoriatic
arthritis (in people with the skin condition psoriasis), ankylosing
spondylitis (which mostly affects the spine), reactive arthritis
(arthritis that occurs as a reaction to another illness in the body),
and arthritis in the temporomandibular joint (where the jaw joins the
skull).
Warning Signs
You might have some form of arthritis if you have:
● Lasting joint pain,
● Joint swelling,
● Joint stiffness,
● Tenderness or pain when touching a joint,
● Problems using or moving a joint normally, or
● Warmth and redness in a joint.
If any one of these symptoms lasts longer than 2
weeks, see your regular doctor or a rheumatologist. If you have a fever,
feel physically ill, suddenly have a swollen joint, or have problems
using your joint, see your doctor sooner. Your health care provider will
ask questions about your symptoms and do a physical exam. He or she may
take x rays or do lab tests before suggesting a treatment plan.
Treating Arthritis
Each kind of arthritis is handled a little
differently, but there are some common treatment choices. Rest,
exercise, eating a healthy, well-balanced diet, and learning the right
way to use and protect your joints are key to living with any kind of
arthritis. The right shoes and a cane can help with pain in the feet,
knees, and hips when walking. You can also find gadgets to help you open
jars and bottles or to turn the door knobs in your house more easily.
In addition, there are also medicines that can help
with the pain and swelling. Acetaminophen can safely ease arthritis
pain. Some NSAIDs (nonsteroidal anti-inflammatory drugs), like ibuprofen
and naproxen, are sold without a prescription. Other NSAIDs must be
prescribed by a doctor. But in 2005, the U.S. Food and Drug
Administration (FDA) warned people about the possible side effects of
some NSAIDs, both those sold with or without a prescription. You should
read the warnings on the package or insert that comes with the drug.
Talk to your doctor about if and how you should use acetaminophen or
NSAIDs for your arthritis pain. You can also check with the FDA for more
information about these drugs.
Some treatments are special for each common type of
arthritis.
Osteoarthritis. Medicines can help you control OA
pain. Rest and exercise will make it easier for you to move your joints.
Keeping your weight down is a good idea. If pain from OA in your knee is
very bad, your doctor might give you shots in the joint. This can help
you to move your knee and get about without pain. Some people have
surgery to repair or replace damaged joints.
Rheumatoid Arthritis. With treatment, the pain and
swelling from RA will get better, and joint damage might slow down or
stop. You may find it easier to move around, and you will just feel
better. In addition to pain and anti-inflammatory medicines, your doctor
might suggest antirheumatic drugs, called DMARDs (disease-modifying
antirheumatic drugs). These can slow damage from the disease. Medicines
like prednisone, known as corticosteroids, can ease swelling while you
wait for DMARDs to take effect. Another type of drug, biologic response
modifiers, blocks the damage done by the immune system. They sometimes
help people with mild-to-moderate RA when other treatments have not
worked.
Gout. If you have had an attack of gout, talk to
your doctor to learn why you had the attack and how to prevent future
attacks. The most common treatment for an acute attack of gout uses
NSAIDs or corticosteroids like prednisone. This reduces swelling, so you
may start to feel better within a few hours after treatment. The attack
usually goes away fully within a few days. If you have had several
attacks, your doctor can prescribe medicines to prevent future ones.
Exercise Can Help
Along with taking the right medicine and properly
resting your joints, exercise is a good way to stay fit, keep muscles
strong, and control arthritis symptoms. Daily exercise, such as walking
or swimming, helps keep joints moving, lessens pain, and makes muscles
around the joints stronger.
Three types of exercise are best if you have
arthritis:
● Range-of-motion exercises, like dancing,
relieve stiffness, keep you flexible, and help you keep moving your
joints.
● Strengthening exercises, such as weight
training, will keep or add to muscle strength. Strong muscles support
and protect your joints.
● Aerobic or endurance exercises, like bicycle
riding, make your heart and arteries healthier, help prevent weight
gain, and improve the overall working of your body. Aerobic exercise
also may lessen swelling in some joints.
The National Institute on Aging (NIA) has a free
80-page booklet on how to start and stick with a safe exercise program.
The Institute also has a 48-minute companion video. See the last panel
of this Age Page for more information. Before beginning any exercise
program, talk with your doctor or health care worker.
Other Things to Do
Along with exercise and weight control, there are
other ways to ease the pain around joints. You might find comfort by
applying heat or cold, soaking in a warm bath, or swimming in a heated
pool.
Your doctor may suggest surgery when damage to your
joints becomes disabling or when other treatments do not help with pain.
Surgeons can repair or replace these joints with artificial (man-made)
ones. In the most common operations, doctors replace hips and knees.
Unproven Remedies
Many people with arthritis try remedies that have
not been tested or proved to be helpful. Some of these, such as snake
venom, are harmful. Others, such as copper bracelets, are harmless, but
also unproven.
How can you tell that a remedy may be unproven?
● The remedy claims that a treatment, like a
lotion or cream, works for all types of arthritis and other diseases,
● Scientific support comes from only one research
study, or
● The label has no directions for use or warning
about side effects.
Areas for Further Research
Recent studies suggest that Chinese acupuncture may
ease OA pain for some people. Others try dietary supplements, such as
glucosamine and chondroitin. Research now shows that these two dietary
supplements may help lessen your OA pain. Scientists are studying
alternative treatments, such as these two supplements, to find out how
they work and if they keep the joint changes caused by arthritis from
getting worse. More information is needed before anyone can be sure.
Talk to Your Doctor
Most importantly, do not take for granted that your
pain and arthritis are just part of growing older normally. You and your
doctor can work together to safely lessen the pain and stiffness that
might be troubling you and to prevent more serious damage to your
joints.
For More Information
Here are other resources about arthritis:
National Center for Complementary and Alternative
Medicine
www.nccam.nih.gov
National Institute of Arthritis and
Musculoskeletal and Skin Diseases
www.niams.nih.gov
American College of Rheumatology/Association of
Rheumatology Health Professionals
www.rheumatology.org
Arthritis Foundation
www.arthritis.org
To get the NIA’s exercise book or video or for
more information on health and aging, call or write:
National Institute on Aging Information Center
The National Institute on Aging website is
www.nia.nih.gov.
To order publications (in English or Spanish) or
sign up for regular email alerts, visit:
www.niapublications.org.
Visit NIHSeniorHealth.gov (www.nihseniorhealth.gov),
a senior-friendly website from the National Institute on Aging and the
National Library of Medicine. This simple-to-use website features
popular health topics for older adults. It has large type and a
‘talking’ function that reads the text out loud.
Information provided by National Institute on
Aging,
U. S. Department of Health and Human Services,
National Institutes of Health
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