TV personality Deborah Norville said that her mother died prematurely “from Rheumatoid Arthritis.”
With all due respect to Ms Norville, no one dies from RA. Like osteoarthritis and many other non-fatal conditions among the genetically susceptible (e.g., Down’s Syndrome, mental illnesses), RA is more a disorder and less a disease.
All of us who live with the condition will die ‘with RA’ just as we will die ‘with a liver’, ‘with a brain’, ‘with fingernails.’ RA is not in the same mortality category as diabetes or stroke, leading causes of death listed on death certificates.
Nevertheless, Rheumatoid Arthritis can be a contributing factor to death from other causes, generally inflammation-related, but one is hard pressed to find any records listing RA as a cause of death by itself. In this list of annual causes of mortality, RA is conspicuously absent.
Any number of studies have concluded that those of us with Rheumatoid Arthritis are doomed to die several years before we would otherwise, usually, they say, from cardiovascular disease (CVD). In vanishingly rare instances inflammation resulting from the disease attacks a vital organ like the heart and the patient may die. Even then the cause of death is inflammation officially coded, for example, as ‘pericarditis,’ not Rheumatoid Arthritis.
It’s clear that a major problem is inflammation. But it’s not the only problem. The other big cause of death for us is the drugs we take, both over the counter and prescription.
There are a number of non-RA-related factors that influence CVD mortality and we who want to die later in life need to pay attention to those the same as everyone else does — things like hypertension, our weight, and, crucially, smoking.
What we don’t need is more lethal medications which too often bring death all by themselves. I have a hunch that heart disease is sometimes a convenient catch-all diagnosis for deaths that were actually caused by pharmaceuticals. Without an autopsy, no one would know the difference. And the number of autopsies on RA patients is infinitesimal.
I could find no reliable estimate for deaths due specifically to arthritis meds but mortality resulting from properly prescribed and properly used FDA-approved prescription drugs, administered in a hospital, was estimated at over 108,000 in 1997, the most current data available. The same study showed that aspirin alone caused almost 10,000 deaths that year. Another 80,000 were hospitalized but survived. Additional deaths from hospital infections (88,000), ‘medical errors’ (98,000), unnecessary surgery (783,000) and other hospital misadventures have made our medical system one of the leading causes of death in the U.S. despite the fact that we are lead to believe that our biggest killers are cancer and heart disease.
It isn’t easy to square these facts with the endlessly repeated mantra that the U.S. has the best medical system in the world.
Fortunately for us, we can solve our problem with Rheumatoid Arthritis on our own.
When it comes to death among those with RA, a few researchers who are coming closer to the truth. Here’s one from Current Opinions in Rheumatology (Italics are mine):
Good control of the inflammation, immunologic disturbances, and metabolic changes seen in rheumatoid arthritis are crucial in the prevention of this potentially lethal complication.
Here’s another from Annals of Rheumatic Diseases:
Patients with rheumatoid arthritis (RA) are known to be at higher risk than patients without RA for adverse outcomes related to cardiovascular disease (CVD), … The exact causes for this increased risk are unknown, but it is assumed that traditional CVD risk factors such as hypertension, hyperlipidemia, family history of CVD, and smoking play a role, as well as RA-related factors including systemic inflammation, vessel injury due to immune complexes, and perhaps medication-related effects on CVD.
A physician who critiqued the research methods described in this article got it right:
This study has several limitations, including a lack of evaluation of the contribution of … medications to CVD risk ….
The bottom line is this: By controlling inflammation, we can control our risk for early death due to heart disease. The safest, surest, way to do that is to modify the factor that causes the inflammation — our diet.
Plus my own free advice: Controlling inflammation by listening to your body and changing the food you eat is within your ability, low cost, and risk free. You don’t have to rely on dangerous drugs to do the controlling for you.