Category Archives: “Treat to target”

Can rheumatoid arthritis kill you?

Here is an email question I received recently…

“I have been in search of a very important question, can you die from RA?  It is listed on a death certificate of a person I know that did not have an autopsy and there were no doctors present when this person died. The person had RA but I am not convinced that this is true and heard you can NOT die from RA alone.  I would appreciate any information you could offer.”

Actually, this is a very interesting question because it brings up an important issue.

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis, affecting more than 2 million Americans.  It is a systemic autoimmune disease that can affect virtually any organ system.

What is not appreciated by many people, including physicians, is that RA has been associated with a significant mortality risk.

It has been estimated from a number of studies that uncontrolled or poorly controlled RA can shorten life span by ten to fifteen years. Despite the many treatment advances made in recent years, early mortality from rheumatoid arthritis remains a significant concern.

So why is that?

The answer lies in the chronic inflammation caused by the RA. The inflammation sets up an autoimmune situation that is perpetually turned on.  Essentially there is no “off-switch.”

Elegant studies done by Dr. Gerald Weissman and colleagues at the New York University School of Medicine implicate chronic gingival inflammation as the underlying trigger.

In any event, this chronic inflammation leads to early atherosclerotic cardiovascular disease. Heart attacks and strokes are the end result.  While this affects all patients, the effect seems to be most pronounced in women.

Some investigations have provided evidence that aggressive intervention with disease modifying anti-rheumatic drugs (DMARDS) and biologic agents may reverse the tendency to early heart attack and stroke.

Another cause of early death can be lung involvement leading to fibrosis and destruction of lung tissue.

Early crippling and disability is rarely seen nowadays.  However, in the past, this too was a significant cause of early death.

Rheumatoid vasculitis is a devastating complication of RA.  This problem occurs as a result of inflammation of blood vessel walls.  The inflammation causes closure of blood vessels to major organs and that obviously can cause major problems.  Immunosuppressive therapy has had mixed results as far as resolution of the problem.  Occasionally, high dose steroids and biologics have been used with some modicum of success.

This discussion would not be complete without a mention of early death related to treatment.  Non-steroidal anti-inflammatory drugs (NSAIDS) used to treat pain and inflammation can cause stomach ulcers, gastrointestinal bleeding, as well as liver and kidney damage.

Disease-modifying drugs such as methotrexate used to slow disease progression may also present problems.  And biologic therapies, even though they have revolutionized our approach to RA, because of their profound effects on the immune system, can also cause complications leading to death.

Nonetheless, when RA is treated appropriately, the benefits of therapy, I think, outweigh the negatives.

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Conventional Medication Combo May Be As Effective As Anti-TNF Agents In RA

Nancy Walsh writing in Medpage Today reported, “Among patients with established rheumatoid arthritis, a combination of conventional disease-modifying drugs was as effective as early use of anti-tumor necrosis factor (TNF) agents,” according to a study presented at the annual meeting of the British Society for Rheumatology. Investigators found that individuals “who received disease-modifying anti-rheumatic drugs (DMARDs) had a change over 12 months on the Health Assessment Questionnaire (HAQ) of 0.45 points compared with 0.30 points for those given anti-TNF therapy.

I disagree with the findings of this study.  Conventional combination DMARDS are touted as being as effective as anti-TNFs by a few rheumatologists.  Personally, I don’t think they work as well and have their own share of potential side effects.

For more information on arthritis treatments and other arthritis problems,  go to:

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Methotrexate reduces risk of death from rheumatoid arthritis by 70%!

Methotrexate may reduce the risk of death in rheumatoid arthritis patients, according to study results published Arthritis and Rheumatism. Researchers assessed the association of mortality and treatment with methotrexate in 5,000 rheumatoid arthritis patients at 10 rheumatology practices in the U.S. The data methotrexate-tabletsused in the study was collected from 1981 to 2005.

Among patients taking methotrexate, there was up to a 70% lower risk of death compared to patients not taking methotrexate. This effect appeared to occur after patients took methotrexate for more than one year. The effect did not continue to increase with longer duration of use. According to researchers, it appears that methotrexate must be taken continuously on its prescribed schedule to maintain therapeutic effects.

For more information on arthritis treatments and other arthritis problems,  go to:

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Long-Term Humira Use … Few Adverse Events

Nancy Walsh writing in MedPage Today reported, “Long-term immunosuppressive treatment with Humira,  a TNF inhibitor drug used in humiradiseases such as rheumatoid arthritis and psoriatic arthritis,  is associated with low rates of adverse events such as serious infections and malignancies, with differences being seen according to the underlying disease,” according to  a study published in the Annals of the Rheumatic Diseases.

Investigators found that “the most frequently reported serious adverse events across indications were infections.” The study indicated that “the most common infections among patients with rheumatoid arthritis were cellulitis – occurring at a rate of 0.3 per 100 patient-years – and pneumonia, seen at a rate of 0.7 per 100.”

For more information on arthritis treatments and other arthritis problems,  go to:

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Treat To Target for Rheumatoid Arthritis

Dr. Steve Paget summarized the “treat to target” approach for rheumatoid arthritis (RA) elegantly in a recent article.  He laid out ten principles that make sense.

rheumatoid-arthritisThey are:

1. The primary target for RA treatment should be clinical remission.

2. Clinical remission is defined as the absence of signs and symptoms of significant inflammation.

3. While remission is the target, low disease activity is an acceptable alternative.

4. Until the treatment target is reached, drug therapy should be adjusted every three months.

5. Measures of disease activity need to be obtained and documented every month for patients with high disease activity and every three months for patients with low disease activity.

6. Validated measures of disease activity should guide treatment decisions.

7. Structural changes and functional impairment shoulkd be considered when making clinical decisions.

8. The treatment target should be maintained indefinitely.

9. The choice of the disease measuring and the level of target should take patient factors, co-morbidities, and drug-related risk into consideration.

10. The patient needs to be informed about the treatment target and how it will be achieved.

For more information on arthritis treatments and other arthritis problems,  go to:

Arthritis Treatment

And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

Just go here Contact