Higher Mortality Linked To RA, Antibodies In Postmenopausal Women

Dr. Enrique Jacome

Mortality rates are two times higher in postmenopausal women with rheumatoid arthritis and anti-cyclic citrullinated peptide antibodies, researchers from the University of Pittsburgh claim. According to the Centers for Disease Control and Prevention (CDC), rheumatoid arthritis (RA) is a systemic inflammatory disease that affects the joints in the body.

The organization also states that patients with RA have a shortened life expectancy and are more susceptible to cardiovascular diseases than healthy individuals. Publishing their results in Arthritis & Rheumatism, the researchers note that rheumatoid arthritis affects 1.3 million adult Americans, with 75% of these being women.

The synovial membrane, which lines the joints, becomes inflamed, which in turn can lead to the cartilage and bone eroding or deforming the joint. Although the exact causes remain unknown, RA is believed to result from a faulty immune response. Typically, the onset of the disease is highest among people in their 60s.

The progress of the disease varies from person to person. Some people may experience "flares" when their symptoms worsen, followed by periods of remission. The more severe form of the disease is active all the time and causes serious joint damage and disability.

Current treatment programs focus on relieving pain and reducing inflammation. This may be achieved through lifestyle changes, medications or surgery.

Selecting participants from the Women's Health Initiative

For this study, doctors from the University of Pittsburgh measured anti-cyclic citrullinated peptide (anti-CCP) antibodies, antinuclear antibodies (ANA) and rheumatoid factor in almost 10,000 women who had reported suffering from RA as part of the Women's Health Initiative.

This is a set of clinical trials and observational studies designed to address the most common causes of death among postmenopausal women. The study participants had a mean age of 64 and the ethnic mix was 65% white, 25% black and 10% Hispanic. The researchers followed them for 10 years.

The results showed that anti-CCP antibodies were prevalent in 8.1% of the women - and 58% of these women reported using disease modifying anti-rheumatic drugs (DMARD). Only 7.3% of the remaining women with negative anti-CCP were using DMARD.

Over the course of the study, 13% of the women died.

Further analysis of the collected data revealed that cardiovascular disease, including stroke and coronary heart disease, and cancer were the main causes of death.

The researchers also found that women with positive anti-CCP faced a significantly higher mortality rate that was independent of DMARD use and modifiable risk factors, such as obesity or smoking.

Dr. Lewis Kuller, one of the study leaders, says:

"Our study is the first large longitudinal study to evaluate anti-CCP, RF, risk factors and mortality. Further investigation to determine specific causes of excess mortality, particularly among RA patients with positive anti-CCP, are needed."

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