Rheumatoid arthritis longterm effects

The Risks of Untreated Rheumatoid Arthritis

Following your RA treatment not only helps ease symptoms like joint pain and stiffness — it can also prevent progression of the disease. Everyday Health

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Staying on top of your rheumatoid arthritis (RA) treatment might seem like an inconvenience at times, but it’s worth it — in fact, the alternative can put your quality of life at risk.

Without proper treatment, RA can cause long-term damage to joints and serious damage to your whole body, along with persistent pain and disability, says David Pisetsky, MD, PhD, a rheumatologist and professor of medicine and immunology at Duke University School of Medicine in Durham, North Carolina. Without proper treatment, over time, your joints may become deformed and lose some of their function.

But on the flip side, the right treatment can go a long way toward preventing long-term damage and preserving joint function. “With current treatment options, most people can have a good control of symptoms and reduce RA progression,” Dr. Pisetsky says. “Many can even experience remission.”

Short-Term Complications of Untreated RA

If left untreated, RA can cause a number of short-term complications, particularly joint pain, Pisetsky says. And because RA affects the entire body, without treatment you may also experience general malaise, fever, and fatigue.

Untreated RA can also increase the risk for infection, Pisetsky says. RA is an inflammatory type of autoimmune disease — meaning when you have RA, the immune system concentrates on attacking your joints and other tissues instead of protecting you from illness. The more severe your RA, the greater the risk for infection, according to the Arthritis Foundation (AF).

When RA Goes Untreated: Long-Term Health Issues

If RA is left untreated in the long-term, it can affect not just quality of life but the duration of it, too. “Persistent inflammation can lead to a shorter lifespan,” Pisetsky explains.

Uncontrolled RA can also increase your risk for heart disease, because RA-related inflammation not only affects the joints, but also the heart. This inflammation can also contribute to narrowing of your blood vessels, according to the AF, allowing plaque to build up.

People who have RA have as much as twice the risk of heart disease as the general population, according to the AF. According to study published in April 2018 in BMC Rheumatology, due to the link between RA and heart problems, it’s important to manage not just RA but heart disease risk factors such as high blood pressure, high cholesterol, smoking, diabetes, and being sedentary.

And the more advanced your RA, the greater your risk for heart damage, the American College of Rheumatology notes.

However, untreated RA can affect more than just your joints and your heart, leading to complications ranging from skin issues, to bone thinning, to eye complications, and beyond.

That said, following a regular treatment plan that helps slow the progression of your RA can help protect your joints, your heart, your overall health and well-being — and your life.

The Importance of Seeking Early Treatment

About 85 percent of those who develop RA sustain joint damage, and most of that damage occurs within the first two years of onset, according to the Johns Hopkins Arthritis Center. Today, many experts recommend early, aggressive treatment to protect vulnerable joints.

Remission is increasingly possible thanks to new therapies, which can be used alone or in combination. Your doctor will work with you to develop a treatment plan that addresses your individual needs. Your RA treatment plan may include non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying anti-rheumatic drugs (DMARDs) — a wide category of immune-suppressing drugs that includes biologics as well as the newest approved RA treatment option, janus kinase (JAK) inhibitors, according to the AF.

In addition, making healthy lifestyle choices, like getting regular exercise, maintaining a healthy body weight, and following an anti-inflammatory diet, like the Mediterranean diet, can help you feel better and promote healthier joints, the AF adds. According to a study published in August 2018 in the journal Arthritis Care & Research, people with RA who were overweight were 25 percent less likely than those at a healthy weight to achieve sustained remission in the first three years following RA diagnosis, despite being on the same treatment. Those who were obese were 74 percent less likely.

Working closely with your rheumatologist can help you find the most effective combination of lifestyle changes and medication to gain control of your RA — and your life.

Even if it takes some time to find the right treatment for you, it’s important to stick with it. Though you may find symptom relief fairly quickly, “finding the right medication for prolonged care can take longer,” Pisetsky explains. “Usually, several months can elapse before it is clear if a treatment is working or not and whether it’s time to try something new.”

Treating RA is a long-term commitment, so find a rheumatologist you feel comfortable with, and don’t get discouraged if a particular drug doesn’t work for you. Give your body time to respond to new medications, and let your doctor know of any concerns you may have about your treatment.

Additional reporting by Erica Patino.

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RA Life Expectancy: Does Rheumatoid Arthritis Affect Life Span?

What is the Average RA Life Expectancy?

Studies have found an association between RA and a shortened lifespan. This is different than saying that RA itself causes a premature death. The complications that develop (hardened or blocked heart arteries, lung scarring, blood cancers, etc.) as a result of an aggressive RA disease course are what put patients at a greater risk for a lower life expectancy.

An exact life expectancy is almost impossible to predict due to the varying nature of the disease. In general, patients can expect that the rheumatoid arthritis life expectancy could be shortened by roughly 10 years to as many as 15 years. This is dependent on a number of factors including but not limited to:

  • — Gender
  • — Age
  • — Personal and family medical history
  • — Lifestyle (past and present)
  • — Overall levels of health and wellbeing

Do not lose hope! Despite these study results, it’s also important to note that many RA patients live well into their 80s and 90s which is an average expected lifespan.

Difference in Life Expectancy Between Men and Women

Women are almost three times more likely to develop RA as men are. Symptoms seen in women are also typically more severe. To add insult to injury, the disease course for women can also be more progressive and can potentially involve more systemic complications.

Predicting a life expectancy for male patients with RA is difficult. While men typically don’t experience the same severity of symptoms as women do, men already have a baseline higher risk of cardiovascular disease than women. When you add the diagnosis of RA, their risk for developing cardiovascular disease and diabetes increases even more than for women (with or without RA).

What Determines Life Expectancy?

RA is an autoimmune disease that makes patients more susceptible to developing other conditions. This can compromise the health of patients long-term. That being said, there are factors that can improve a patient’s life expectancy through mitigating the complications experienced during the disease course.

Age at Diagnosis

Patients who are diagnosed with RA at a young age generally experience more severe symptoms. This is thought to be in part because the duration of the disease is longer. As a result, this longer disease duration could potentially lead to a shortened life expectancy for some patients.

Complications

Patients with RA are at greater risk of developing more severe health complications due to a weakened immune system and chronic symptoms.

Some cancer rates are higher in RA patients, specifically lymphoma. Breathing problems also tend to present themselves in RA patients. This is due to the ongoing inflammation in the lungs with leads to respiratory issues and lung scarring.

RA patients are at a much greater risk of developing heart disease than the general population. It is estimated that as many as half of the deaths in RA were caused by heart disease. The exact link between rheumatoid arthritis and heart disease is unknown. However, it is suspected the increased inflammation leads to earlier and faster development of hardened heart blood vessels.

Smoking

Quitting smoking is highly advised for all RA patients. Research has shown a strong link between patients who smoke and the increased severity of RA symptoms. Smoking causes lung inflammation, which can possibly activate the RA antibodies to further aggravate and escalate the disease course.

With an already weakened immune system, RA patients should also avoid smoking because on its own it leads to chronic respiratory disorders. When compounded with the diagnosis of RA, especially in seropositive RA patients, these disorders are more likely to develop more quickly than in non-RA smokers.

Seropositive vs. Seronegative

One study showed that seropositive patients were three times more likely to die from respiratory complications than seronegative patients were. There is a proposed link between seropositive patients and more aggressive symptoms of lung nodules and lung scarring.

Can RA Be Fatal?

RA alone is not fatal. Fatality occurs due to complications associated with the inflammation caused by RA. In severe cases, patients can develop other medical conditions. The other medical conditions that patients need to be aware when it comes to shortened RA life expectancy include:

  • Heart disease
  • Diabetes
  • Stroke
  • Cancer – especially lymphoma
  • Respiratory conditions like Chronic Pulmonary Obstruction Disorder (COPD)
  • Infection

Off course, these are conditions that everyone should be concerned about. Keeping your body healthy through diet, exercise, and positive habits will go a long way to reducing the risk of fatality from any of these conditions.

How Does Treatment Improve Life Expectancy?

Early treatment greatly improves the prognosis of RA patients. If treatment begins before symptoms cause too much damage, patients can generally go on to live a better (maybe even almost normal) quality of life.

Ongoing treatment and monitoring can help rheumatologists provide the most appropriate and personalized care for their patients. Each patient will experience a different set of symptoms over their lifetime. Doctors look for warning signs of other complications associated with RA and work to either prevent them or treat them as they develop.

The main goal of treatment is to reduce pain and improve quality of life. Many patients experience very effective treatment plans and continue to live their lives making appropriate lifestyle adjustments along the way.

Arthritis

Because there are several types of arthritis, it’s important to know which one you have. There are some similarities between these conditions, but there are also some key differences.

Osteoarthritis

The most common type of arthritis is osteoarthritis. It is estimated that around 8.75 million people in the UK have seen a doctor about osteoarthritis.

Osteoarthritis starts with the roughening of cartilage.

If this happens, the body can put in place a ‘repair’ process to try to make up for the loss of this important substance. The following can then happen:

  • Tiny bits of extra bone, called osteophytes, can grow at the ends of a bone within a joint.
  • There can be an increase in the amount of thick fluid inside the joint.
  • The joint capsule can stretch, and the joint may lose its shape.

Sometimes, the early stages of osteoarthritis can happen without causing much pain or trouble. However, it can lead to damage inside a joint, as well as pain and stiffness.

Osteoarthritis is more common in women and usually affects people from the age of 45 onwards. The parts of the body most commonly affected are the knees, hands, hips, and back.

Keeping active will help you maintain a healthy weight, and this will reduce the pressure on your joints. Doing regular exercise will keep muscles around a joint strong, and this will help to support and stabilise a joint affected by osteoarthritis.

Being overweight can make you more likely to get osteoarthritis and can make it worse.

Taking painkillers, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen can help reduce your symptoms and allow you to stay active. Keeping active will also reduce pain, stiffness and swelling.

There are NSAID creams that you can rub into the affected area. It might be an idea to try these first.

There is a range of pain relief options available. If you’re finding the pain of osteoarthritis difficult to cope with, a doctor or physiotherapist would be able to give you specific advice.

If your osteoarthritis becomes severe, particularly in your knees and hips, your doctor might discuss with you the possibility of surgery. This is usually considered only after you’ve tried all the other treatment options.

Joint replacements are now very sophisticated and successful.

Gout and calcium crystal diseases

Gout is a type of inflammatory arthritis that can cause painful swelling in joints. It typically affects the big toe, but it can also affect other joints in the body.

Joints affected by gout can become red and hot. The skin may also look shiny and can peel.

It’s caused by having too much urate, otherwise known as uric acid, in the body. We all have a certain amount of urate in our body.

However, being overweight or eating and drinking too much of certain types of food and alcoholic drinks can cause some people to have more urate in their bodies. The genes you inherit can make you more likely to develop gout.

If it reaches a high level, urate can form into crystals that remain in and around the joint. They can be there for a while without causing any problems and even without the person realising they are there.

A knock to a part of the body or having a fever can lead to the crystals falling into the soft part of the joint. This will cause pain and swelling.

There are drugs that can reduce the amount of urate in the body and prevent gout attacks. Examples are allopurinol and febuxostat. If you’re having a gout attack, you’ll also need short-term pain relief. Non-steroidal anti-inflammatory drugs (NSAIDs) as well as paracetamol can be good drugs to try first.

Men can get gout from their mid-20s, and in women it’s more common after the menopause. Taking water tablets can increase the risk of gout.

There are also conditions that cause calcium crystals to form in and around joints.

We all need calcium to make bones and teeth strong. However, some people can have too much calcium in their bodies, which can then form as crystals around joints. This can lead to painful swelling.

Calcium crystal diseases tend to clear up on their own. Taking painkillers and NSAIDs, and applying an ice pack wrapped in a damp towel, can soothe the pain and swelling.

Rheumatoid arthritis

Rheumatoid arthritis is a type of inflammatory arthritis. It is what is known as an auto-immune condition.

The immune system is the body’s natural self-defence system, and it protects us from infections and illness. When someone has an auto-immune condition, the body’s immune system mistakenly attacks the body’s healthy tissues, such as the joints, causing inflammation.

Inflammation is normally an important tool in the immune system. It occurs when the body sends extra blood and fluid to an area to fight an infection. This is what is happening for example if you have a cut that gets infected, and the skin around it becomes swollen and a different colour.

However, in rheumatoid arthritis the inflammation and extra fluid in a joint can cause the following problems:

  • It can make moving the joint difficult and painful.
  • Chemicals in the fluid can damage the bone and joint.
  • The extra fluid can stretch the joint capsule. Whenever a joint capsule is stretched, it never quite returns to its original position.
  • Chemicals in the fluid can irritate nerve endings, which can be painful.

As well as causing pain and stiffness, inflammation can cause permanent damage to a joint. Starting effective treatment early on can help to minimise damage.

Symptoms of rheumatoid arthritis can include:

  • swollen and tender joints
  • swelling and stiffness in joints in the morning that lasts for longer than half an hour
  • severe tiredness, also called fatigue
  • a general feeling of being unwell.

Rheumatoid arthritis often starts in the small joints of the hands and feet, and it can affect the same joints on both sides of the body at the same time. It can start quite slowly and then gradually get worse, or it can start more aggressively.

Rheumatoid arthritis can affect adults of any age. It most commonly starts among people between the ages of 40 and 60. It’s more common in women than men.

There are drugs that can slow down an over-active immune system and therefore reduce the pain and swelling in joints. These are called disease-modifying anti-rheumatic drugs (DMARDs) and include biological therapies.

If you have rheumatoid arthritis, treatment will start with conventional DMARDs. These can have the overall effect of reducing the activity of your immune system, which is overactive and causing damage to your body.

If these drugs have been tried and don’t work, doctors will look at the possibility of trying the newer biological therapies. Biological therapies have a more targeted effect on the immune system.

Spondyloarthritis

Spondyloarthritis is a word used to describe a number of conditions that cause pain and swelling, mainly around the joints of the spine.

In these conditions there is inflammation of small pieces of connective tissues, called entheses. These are tough little cords that join either ligaments or tendons to bones.

Ankylosing spondylitis

Ankylosing spondylitis is a type of spondyloarthritis and it causes pain and swelling, mainly around the joints of the spine.

In this condition, in response to inflammation around the spine, the body can create more of the mineral calcium. This mineral is normally used by the body to make bones strong. However, in ankylosing spondylitis the extra calcium can make new bits of bone grow in the spine, and this will cause pain and stiffness.

This condition typically causes pain in the second half of the night, and swelling of your back in the morning that lasts for more than half an hour.

There are drugs that can slow this process down. Keeping active will help to minimise stiffening of the spine, while maintaining a good posture will help prevent increased curving of the spine.

Ankylosing spondylitis usually occurs between the ages of 20 and 30. It is more common among men.

Psoriatic arthritis

Psoriatic arthritis is an auto-immune condition. It is also a type of spondyloarthritis.

The body’s immune system can cause painful swelling and stiffness within and around joints, as well as a red scaly skin rash called psoriasis. The rash can affect several places in the body, including the elbows, knees, back, buttocks and scalp.

It is also common to have severe tiredness, otherwise known as fatigue.

Disease modifying anti-rheumatic drugs (DMARDs) and biological therapies can treat the cause of the inflammation in joints. There is also a variety of treatments, such as creams and medications, for psoriasis.

Psoriatic arthritis usually affects people who already have psoriasis. However, some people develop the arthritis before the psoriasis. It’s possible to have the arthritis but no psoriasis at all.

This condition can affect people of any age, but tends to affect adults.

Juvenile idiopathic arthritis (JIA)

If someone is diagnosed with inflammatory arthritis before their sixteenth birthday, it’s called juvenile idiopathic arthritis, or JIA.

There are different types of JIA. They are auto-immune conditions, and the immune system can cause pain and swelling in joints.

The earlier someone is diagnosed with JIA, the better. This is so that effective treatment can be started and limit any damage to the body.

There are drugs that can treat the symptoms, such as painkillers and non-steroidal anti-inflammatory drugs (NSAIDs). Disease-modifying anti-rheumatic drugs (DMARDs) and biological therapies can slow down or stop the arthritis causing the swelling inside the body.

There are about 12,000 young people in the UK who have JIA.

Early Treatment Boosts Long-term Rheumatoid Arthritis Outcomes

Improved treatment, including early treatment, for rheumatoid arthritis appears to have long-lasting benefits for patients and may be contributing to reduced arthritis-related mortality in many countries, according to a pair of studies published in Arthritis & Rheumatology.

Rheumatoid arthritis has been linked to increased disability, reduced quality of life, and increased mortality. But advances in treatment for the disease, including a shift toward early treatment and use of newer medications, during the last 2 decades have led to improved patient outcomes in the near term. However, less is known about the long-term effect of the updated treatment approaches on quality of life and arthritis-related deaths.

To better understand the long-term effects of treatment, James Gwinnutt, BS, from the University of Manchester in the United Kingdom, and colleagues analyzed data from the Norfolk Arthritis Register, which recruited patients between 1990 and 1994 and followed up with them periodically over the course of 20 years. They stratified the 602 patients into three groups: those who received early treatment, those who received late treatment, and those who did not receive treatment because their symptoms were not severe enough to warrant it.

On average, disease severity, as determined by swollen and tender joints, remained low for all groups during the follow-up period. Disability rates initially fell for participants; however, after year 7, they increased above baseline and continued to increase for the duration of follow-up.

The patients who received early treatment had disability rates comparable to those whose symptoms were mild enough to forgo treatment (β, 0.03; 95% confidence interval , −0.06 to 0.12), whereas patients who received late treatment experienced increased disability compared with the no treatment group (β, 0.10; 95% CI, 0.02 – 0.17).

During the study, 265 (44%) patients died. There was no significant difference in mortality in either treatment group compared with the no treatment group.

“This research emphasizes the importance of early treatment and the long-term benefits of early treatment,” said senior author Suzanne Verstappen, PhD, from the Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, United Kingdom, in a press release.

“In the early 1990s, when this study started, only 30 percent of patients received early treatment, but this number has increased significantly in the last decade,” Dr Verstappen continued. “It’s expected that in the next 10 years, newly diagnosed patients will have a better future with respect to functional ability, less severe disease activity, and improved quality of life.”

Mortality Down in Global Study

A second study published at the same time found reduced rates of rheumatoid arthritis–related mortality globally between 1987 and 2011. In the study, Aliasghar Kiadaliri, PhD, from Lund University in Sweden, and colleagues analyzed data on 31 countries in Europe, North America, and Australasia from the World Health Organization mortality database.

The authors found that arthritis-attributed deaths fell from 9281, or 0.12% of all deaths, in 1987 to 8428, or 0.09% of all deaths, in 2011. The average decline in arthritis-related mortality was 3% per year.

Twenty-one of the countries saw reductions in arthritis-related mortality of 25% or more during the study period, whereas three countries experienced increases, suggesting substantial variation remains between countries.

Dr Kiadaliri and colleagues attributed the mortality declines to several factors, including improved treatments and milder forms of rheumatoid arthritis.

Although the mortality findings are welcome, they may also have important policy implications for countries with growing numbers of elders living with arthritis.

“Although increased survival with rheumatoid arthritis is great news, it might lead to a greater share of our aging population having the disease and in need of health services,” said Dr Kiadaliri in a press release.

“This needs to be accounted for in health care planning.”

The authors have disclosed no relevant financial relationships.

Arthritis Rheumatol. Published online April 20, 2017. Gwinnutt abstract, Kiadaliri abstract

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