Although rheumatoid arthritis (RA) is not a fatal disease, it is associated with health complications such as lung and cardiovascular disease. These complications may raise mortality rates and lower life expectancy. Fortunately, management strategies can lessen the risk of RA complications and promote overall health.

RA and Life Expectancy

Life expectancy is impacted by several genetic, environmental, and lifestyle factors. Although many people with RA live long lives, studies demonstrate that the condition can shorten life expectancy by an average of 10 years compared to the general population. Additional research is needed to understand the reasons behind this shortened life span. However, several indicators are linked to reduced life expectancy, including:

• Being young when you develop the RA
• Having a long disease duration
• Having underlying health problems
• Having a severe RA diagnosis, as indicated by significant joint damage or organ involvement
• Having seropositive RA, which occurs when certain proteins known as anti-cyclic citrullinated peptides (anti-CCPs) are present in the bloodstream

Smoking also increases the risk of death in those with RA. One study found that, over five years, smokers’ death rates were nearly twice that of nonsmokers. Heart disease was the leading cause of death in this study. However, the effect of smoking on death risk falls significantly once a person quits.

Fortunately, earlier diagnoses and newer treatments have lessened the impact of RA on life span. A recent study found declining death rates over a 15 year period in individuals with RA.

Health Conditions Linked To RA

RA is associated with several comorbidities, meaning more than one disease is present at the same time. Common comorbidities of rheumatic diseases such as rheumatoid arthritis include:

• Cardiovascular disease
• Lung disease
• Infections
• Cancers

Although these comorbidities are associated with a decreased life span, close medical monitoring and treatment can help those with RA manage their risk.

Cardiovascular Disease

People with RA are at a higher risk for heart and other cardiovascular diseases. People with RA are nearly twice as likely to develop heart disease, and heart disease accounts for almost a third of deaths in those with RA. Studies show that death from heart disease occurs, on average, 10 years earlier in people with RA compared to the general population.

RA increases the risk of ischaemic heart disease, a condition where the blood vessels become blocked, limiting blood flow and oxygen reaching the heart. Several factors may underlie the increased risk of cardiovascular diseases, including:

• Chronic inflammation
• Changes in blood vessel function
• Inflammation of the blood vessels themselves (known as vasculitis)
• Abnormal blood clotting

People with RA are also more likely to develop high blood pressure and high cholesterol. Together, these risk factors increase the chance of heart attack, heart failure, and stroke.

Read more about RA and heart disease.

Lung Disease

Lung complications occur in 30 percent to 40 percent of people with RA and are linked to nearly 10 percent of deaths in those with the condition.

Lung problems linked with RA include:

• Pulmonary nodules, small growths in the lungs
• Pleural effusion, the accumulation of fluid between the lung and chest wall
• Bronchiectasis, airway damage
• Interstitial lung disease (ILD), characterized by inflammation and scarring of the lung tissue

In RA, the scarring associated with ILD is caused when the body's overactive immune system attacks the lungs. Some RA medications, such as methotrexate and tumor necrosis factor (TNF) inhibitors, are also linked to ILD. Over time, excessive scarring leads to breathing difficulties. Nearly 10 percent of those with RA develop ILD at some point during their disease, and some may need lung transplants.

Read more about RA and lung disease.

Cancer

People with RA are more likely to develop certain types of cancer, including lung cancer and lymphoma. The risk of lymphoma — a cancer of the lymphatic system, part of the circulatory and immune systems — is double in those with RA than in the general population. Cancer risk is highest in those with high disease activity and those undergoing aggressive treatment.

Although additional research is needed, the altered function of the immune system seen in RA may decrease the body’s ability to fight cancer. Also, many RA medications work through anti-inflammatory mechanisms by turning down the immune response. Although effective for treating RA, these medications may also limit the body’s anti-cancer pathways.

Infection

Although most infections in people with RA are easily treatable, serious infections can occur. Some RA medications, such as Azasan (azathioprine), Cytoxan (cyclophosphamide), and corticosteroids, can increase the risk of infections due to their impacts on the immune system. Biologic therapies, including TNF inhibitors, are associated with an increased risk of serious infections, such as tuberculosis (TB) in those who have been previously exposed to TB.

Managing Risk and Supporting Overall Health

Seeking early and regular care with a rheumatologist can help those with RA successfully manage their disease and limit health complications. Studies show that sustained control of RA disease activity improves both quality and length of life.

Both you and your doctor should be on the lookout for new or worsening symptoms that may indicate an underlying health condition, such as:

• Fever
• Weight loss
• Chest pain
• Fatigue
• Breathing difficulties

Additional medical screening may be needed to test for other health problems. Regular blood pressure and cholesterol screens are often used to monitor for cardiovascular disease.

Early diagnosis and treatment with RA medications, including disease-modifying antirheumatic drugs (DMARDs) and biologics, can help slow disease progression. In addition to using medications, those with RA can follow self-management strategies to limit the risk of other health conditions.

Strategies to increase both quality of life and life span in those with RA include:

• Keeping physically active — Regular exercise can help with RA pain and joint stiffness and reduces the risk of developing heart and lung disease.
• Stopping smoking — Cigarette smoking worsens RA symptoms, causes other medical problems, and increases death risk in those with RA.
• Maintaining a healthy weight — Obesity is linked to RA complications and many other chronic health conditions. Using diet and exercise to manage weight can help reduce the risk of health problems.
• Managing blood pressure and cholesterol — Diet, exercise, and medications can be used to maintain healthy blood pressure and cholesterol levels.

Talk With Others Who Understand

By joining myRAteam — the social network for people with rheumatoid arthritis and their loved ones — you can connect with more than 146,000 other members who understand life with RA. Every day, members come together to ask questions, give advice, and share their stories.

Are you concerned about how RA may impact your life span? Share your experience in the comments below, or share your story on your myRAteam.