Biologics, treatment-to-target, CVD prevention are likely factors
Mortality rates among patients with rheumatoid arthritis (RA) have come down over the past decade or so but are still 40% to 50% higher among patients with RA than the general population, Canadian researchers report.
When you think about who’s at risk for osteoporosis, a stereotypical portrait probably comes to mind: a thin Caucasian or Asian woman who’s over age 50. But if you have rheumatoid arthritis (RA), add yourself to that picture.
In fact, according to a 2010 study in Arthritis Research & Therapy, people with RA are 1.5 times more likely to experience an osteoporosis-related fracture than those who don’t have RA. The study, which looked at the medical claims records of about 47,000 U.S. residents with RA and 235,000 without it, found that women face the greatest odds, but men are at risk as well. What’s more, the increased risk of fracture is seen across all age groups, although the chances of experiencing a fracture heighten with age. The most likely location of a fracture? The hip, followed by the pelvis, thighbone and wrist.
What raises the risk? Although scientists are still trying to sort out why people with RA are more likely to develop osteoporosis than others, they do know some of the factors that heighten risk.
- Disease activity. In addition to the joint damage that the disease’s chronic inflammation may cause, RA itself appears to trigger bone loss in the affected joint as well as other bones throughout the body. Some studies suggest that proteins that control inflammation (cytokines) also regulate cells called osteoclasts that are responsible for breaking down bone.
- Corticosteroids. These medications are frequently prescribed to slow the progress of RA. Examples of medications in this category include prednisone, prednisolone, dexamethasone and cortisone. Unfortunately, corticosteroids (also called glucocorticoids) jump-start bone loss by suppressing bone formation and increasing bone breakdown. They also interfere with the way the body uses calcium and lower the levels of sex hormones (estrogen and testosterone), both of which add to bone loss. Although short-term use doesn’t appear harmful to bones, anyone taking corticosteroids for more than three months raises his or her risk of osteoporosis.
- Lack of exercise. The pain and damage caused by RA can limit both your ability and your desire to exercise. But making the effort to do some exercise is important: The tug of muscles on bones whenever you move strengthens your bones.
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Too much expert litigation work with attorneys. Can you tell?
The average age at death for RA patients in a cohort that enrolled patients between 1986 and 1998 was 76.7 years (95% CI 75-78.1), while for a cohort that enrolled patients between 2002 and 2012, the average age of death was 86.7 (95% CI 84.1-89.5), according toSam Norton, PhD, of King’s College in London.
Patients with rheumatoid arthritis (RA) have an increased incidence of diastolic dysfunction, which may further raise their already high risk for congestive heart failure, a meta-analysis suggested.
Patients with RA have double the incidence of heart failure compared with the larger population, and this finding has prompted interest in determining the origins of heart failure in these patients.
The FDA has expanded the black box warning to the label of the rheumatoid arthritis drug leflunomide (Arava) to include possible fatal liver damage.
The agency received 49 adverse event reports — including instances of jaundice, coagulopathy, encephalopathy, and 14 fatalities — about the drug from August 2002 to May 2009. Of the patients reporting adverse events, 36 were hospitalized.