Gout and Life Expectancy

Gout is the most common type of inflammatory arthritis, affecting more than 4% of adult Americans. It occurs in some people who have high blood uric acid levels. Gout is more common in men, postmenopausal women, and people with kidney disease.

When acid crystallizes into needle-like structures in a joint, pain, tenderness, redness, warmth, and swelling may suddenly and severely worsen.

However, there is much more to gout than just the stabbing pain in the big toe, which is its most well-known symptom. Gout has also been linked to a number of other conditions, including metabolic syndrome and cardiovascular disease.

Furthermore, a new study discovered that people with gout have a 25% higher risk of dying prematurely than people without gout. Gout patients must work with their doctor to lower their uric acid levels to the target of 6 mg/dl – and keep them there for the rest of their lives – to reduce that risk.

Not only that but people with gout must manage other gout-related medical conditions such as hypertension, heart disease, and kidney disease.

Can Arthritis Reduce Your Life Expectancy?

There are more than a hundred different types of arthritis. Some, like rheumatoid arthritis (RA), an autoimmune disease in which the immune system attacks healthy cells, and gout, which may lead to serious complications if left untreated, are progressive and may shorten one’s life.

Arthritis is not fatal in and of itself, but complications in more severe cases may shorten life by six to seven years, according to research. There are numerous ways to reduce your chances of developing arthritis complications.

Types of Arthritis that May Potentially Shorten Your Life

#1) Gout

Gout is caused by an excess of uric acid in the body (hyperuricemia), which forms crystals around the joints, causing intense pain and swelling. When your body breaks down purines, which are found in your body and some foods, such as red meat and certain types of seafood, it produces uric acid.

Uric acid crystals (monosodium urate) may form in the joints, fluids, and tissues when there is an excess of uric acid in the body. Gout is also linked to a number of comorbidities, including metabolic syndrome, cardiovascular disease, and chronic kidney disease. All of these may potentially contribute to increased gout mortality rates.

#2) Rheumatoid Arthritis (RA)

Rheumatoid arthritis is an autoimmune and inflammatory disease that occurs when the immune system malfunctions and attacks the joint lining (called the synovium). The inflamed synovium thickens, making the joint area painful and tender, as well as red and swollen. Furthermore, moving the joint can be difficult.

RA usually affects the hands, knees, or ankles, and it affects the same joint on both sides of the body. Other parts of the body, such as the eyes, heart and circulatory system, and lungs, may be affected by RA.

As a result, people with RA are more likely to have comorbidities, which increase mortality even when the disease is in remission.

#3) Psoriatic Arthritis

About 30% of people with the skin condition psoriasis have psoriatic arthritis (PsA), an inflammatory type of arthritis. 3 PsA is an autoimmune disease, just like psoriasis.

Psoriasis symptoms include patches of inflamed, red skin that are frequently covered in flaky white scales. In 85% of those with psoriatic arthritis, psoriasis first manifests before joint problems.

PsA patients experience painful, stiff joints along with surrounding tissue swelling, heat, and redness. According to research, a higher cardiovascular risk in more severe PsA cases may increase mortality.

#4) Diffuse Scleroderma

Diffuse scleroderma is a scleroderma subtype characterized by excessive collagen production, which results in skin thickening over large areas of the body, most commonly the fingers, hands, arms, anterior trunk, legs, and face. Musculoskeletal pain characterizes this condition.

Significant organ damage is possible, including damage to the gastrointestinal tract, kidneys, lungs, and heart. Organ failure is the leading cause of death in diffuse scleroderma patients.

Acute severe systemic high blood pressure may damage the kidneys, and severe lung or heart disease may be life-threatening.

Factors That May Influence Arthritis Life Expectancy

Chronic Inflammation

If you have arthritis, chronic inflammation may shorten your life. Chronic inflammation, such as that caused by RA, may result in joint fusion, generalized bone loss, osteoporosis, and fractures if not adequately treated early on.

Osteoporosis was 1.5 to twofold more common in RA patients than in the general population. Osteoporosis increases the likelihood of femoral neck and vertebral compression fractures, lowering quality of life and increasing mortality.

Duration of the Disease

People with progressive forms of arthritis, such as RA, are living longer lives as new and better medications become available, but this also means they have a longer disease duration.

The risk of comorbidities thus becomes a central issue in those living with RA, particularly because comorbidity may jeopardize long-term prognosis improvement in RA patients.

Autoimmune Disease

Immunosuppressive drugs are used to treat autoimmune diseases. These may help to lower the body’s defenses against infections, making a person more susceptible to illness.

It is well known that RA patients, who are frequently treated with disease-modifying anti-rheumatic drugs (DMARDs), have a higher risk of infection than people in general, and that serious infection is one of the leading causes of death in RA.

The lower respiratory system is the area that is most frequently impacted. In addition, the skin, soft tissues, bloodstream, bones, joints, and the urinary tract are frequently impacted.

Seropositive RA

Anti-cyclic citrullinated peptide (anti-CCP) and/or rheumatoid factor (RF) antibodies in the blood are considered seropositive RA. Seropositivity is associated with higher mortality in RA patients than seronegativity.

In one study, patients with higher autoantibody titers died at a higher rate than those with lower titers.

Diseases Left Improperly Treated

Inflammatory forms of arthritis may be extremely harmful to a person’s health if left untreated. DMARDs and other biologics may significantly lower RA mortality rates.

A small study, for example, discovered that people treated with biologic agents had a 12.6% mortality rate, DMARDs had a 22.3% mortality rate, and no treatment had an 89.1% mortality rate.

Treatment is thus critical for increasing the life expectancy of people with RA.

Other Potential Risk Factors

1. Your age: The age at which symptoms first appear can be used to predict age severity. A prospective cohort study of 950 RA patients found that those who developed symptoms later in life had more radiological damage at the onset of the disease and over time.
2. The biological sex: There is conflicting evidence on whether females are more likely than males to develop RA. However, autoimmune diseases are more common in women. According to one study, females are diagnosed with gout more frequently than males as they age.
3. Genetics: According to one study, genetics determines between 40% and 60% of the risk of developing RA. Genetic polymorphisms related to renal urate excretion have also been discovered to affect serum uric acid levels and the risk of gout.
4. Being overweight/obese: Obesity has been linked to a higher incidence of gout. Weight loss increases the likelihood of successful treatment, but it has also been associated with increased arthritis activity in RA and PsA and a decreased likelihood of response to anti-tumor necrosis factor (TNF) agents, a class of biologic drug.
5. Your diet: Two examples of foods connected to a higher incidence of gout are alcohol and sugary drinks. A healthy diet can help you manage your weight and other aspects of your general health. Dairy products may provide some protection against gout while meat and seafood have been linked to an increased risk of the condition.

Potential Complications Caused by Arthritis

Heart Disease

Despite having different underlying causes, rheumatoid arthritis and gout are both associated with a 50% to 70% increased risk of cardiovascular disease when compared to the general population.

This increased risk is attributed to RA’s chronic inflammatory process and uric acid crystal accumulation in the heart. Both conditions are considered distinct cardiovascular risk factors.

Early RA treatment has been shown to reduce the risk of cardiovascular disease. However, evidence that urate-lowering therapy consistently improves cardiovascular outcomes is still lacking.

Cancer

According to several studies, people with RA have roughly twice the average risk of developing lymphoma. This is most likely due to chronic immune system inflammatory stimulation.

Lymphocytes known as B cells and T cells, which are key producers of inflammation, are also the cells that become cancerous in lymphomas. Because of the increased activity of these lymphocytes in RA, they are more likely to become malignant.

Cancer risk may be increased by medications that suppress the immune system. This appears to be the case with a few medications used infrequently to treat RA, such as cyclophosphamide and azathioprine.

However, methotrexate, one of the most popular RA medications, has been connected to lymphoma. Patients with Epstein-Barr virus who take methotrexate for RA are more likely to develop lymphoma.

In addition, gout sufferers are more likely to develop lung, urological, and digestive system cancers.

Damage to the Organs

Multiple organ diseases such as RA, gout, and PsA may all have systemic effects. RA has the potential to cause liver damage in addition to heart damage. The presence of asymptomatic cardiovascular organ damage in RA patients is linked to hypertension that is unrelated to inflammatory activity.

Anemia

Anemia of chronic disease is a form of anemia that many RA patients have (ACD). PsA sufferers may also experience mild anemia. A person with ACD may have low blood iron levels despite having normal or occasionally increased amounts of iron stores in their body tissue.

Anemia results from the body’s inability to use the iron it has stored to produce new red blood cells as a result of chronic inflammation. A particular hormone called erythropoietin, which regulates the production of red blood cells, may be impacted by inflammation.

Patients Who Do Not Meet the Optimal Serum Urate Target

According to a 2018 ACR/ARHP Annual Meeting, failure to achieve a serum urate target of 6 mg/dl predicts mortality in gout patients. Furthermore, to improve a patient’s chances of survival, a treat-to-target gout control strategy should be considered.

Doctors currently recommend two approaches for hyperuricemia in gout:

1. treat-to-target interventions to achieve therapeutic serum urate levels
2. treat to flare unless severe gout develops.

This new study finds that, while there is still a risk of developing severe gout, meeting the serum urate therapeutic target is associated with a lower risk of death than exceeding the target.

Gout and Rheumatoid Arthritis (RA) Mortality Rates

Unlike rheumatoid arthritis (RA) mortality rate, this increased mortality rate in gout patients has not improved over the last 16 years. Researchers noted that the lack of improvement in gout mortality rates contrasts sharply with what has occurred in rheumatoid arthritis mortality rates.

Doctors believe the improvement is due to better RA treatment options. Furthermore, doctors tend to use medications earlier and more aggressively in order to achieve certain treatment goals. This method is known as “treat to target.”

As an inflammatory disease, gout tends to be treated much more casually than RA, according to doctors. They go on to say that gout is a chronic inflammatory condition that is four times more common than RA. Nonetheless, most people think of it as sporadic bouts of joint pain.

However, as most gout patients are aware, inflammation is always present in the joints of people who have gout. Even after the symptoms of an acute gout attack have subsided, inflammation persists.

The vast majority of gout patients, according to doctors, should be treated with urate-lowering medication. Only a small portion of people receive treatment, though. Even fewer actually use it frequently and for long enough to break up the uric acid crystals that are the root of the underlying, persistent inflammation.

A study was conducted to evaluate the risk factors for gout patients’ survival and lethal outcomes. They concluded that gout patients have a high mortality rate. In areas with high overall mortality, 7-year survival was 85%. Cardiovascular diseases killed two-thirds of the patients. Gout patients with normuricemia have the same chance of survival as those with hyperuricemia.

So, if you have gout, here’s what you should do to live the longest, healthiest life possible:

• Take your gout medication and other medications exactly as prescribed.
• Check for and treat comorbid conditions.
• Achieve and keep a healthy weight.
• Exercise on a regular basis.
• Maintain a gout-friendly diet.

Uncontrolled High Levels of Uric Acid

According to a recent study, the systemic inflammation brought on by gout likely explains why patients who don’t control their uric acid levels are more likely to pass away before their time.

The researchers followed nearly 1,200 gout patients in Spain from 1992 to 2017. Those with higher-than-normal uric acid levels (greater than 6 mg/dL) during the first year after diagnosis were found to be significantly more likely to die from cardiovascular disease or any other cause during the study period.

Anyone with gout should take medication that enables them to keep their blood uric acid level below 6 mg/dL, according to the European League Against Rheumatism (EULAR). Typically, this entails taking an allopurinol or other uric acid-lowering medication.

Patients who died during the study’s follow-up period were more likely to have had gout, tophi, and pre-existing cardiovascular disease affecting multiple joints. Tophi are crystal deposits that can be seen or felt under the skin. According to research, increasing gout severity is associated with an increased risk of death, which is reflected in the number of tophi.

These patients were also more likely to be elderly (average age 75, compared to an average age of 58 for the survivors). Uric acid levels, on the other hand, appeared to have a greater impact on mortality than any of the other factors.

The good news is that patients are more likely to stay healthy if they work with their doctors to monitor their uric acid levels and take medication as prescribed. The use of uric acid management strategies is likely to enhance patient outcomes and provide survivors with benefits beyond gout relief.

Reduced Uric Acid Levels Could Save Your Life

According to new research, using a “treat-to-target” strategy may be the best way to significantly reduce the risk of premature death. The new study, led by the same group of Spanish scientists, aimed to see if lowering uric acid levels in the blood (serum urate) to normal (less than 6 mg/dL) made a difference.

Participants’ average uric acid levels at the start of the study were 9.1 mg/dL. Most patients were able to lower their levels below 6 mg/dL as a result of treatment. 16 percent of people still had too much uric acid in their blood, though. Researchers found that study participants with persistently elevated uric acid levels had a markedly increased risk of passing away.

The authors took into account additional factors like high BMI, alcohol consumption, diabetes, and hypertension that could affect mortality risk. High uric acid levels nevertheless stood out as a distinct risk factor.

Western Sweden’s Death Risk and Cause-Specific Mortality

According to one study, cardiovascular diseases are to blame for the increased mortality in gout patients (CVD). Given the general population’s decline in CVD mortality, we wanted to assess overall mortality in gout as well as cause-specific contributions to mortality beyond CVD and temporal trends.

Life expectancy is rising worldwide, including in Sweden. This is largely explained by a decrease in CVD mortality as a result of improved cardiovascular health care. Reduced mortality in rheumatoid arthritis has also been observed in recent decades.

This may be explained by a decrease in CVD mortality. A similar trend, however, has not been observed in gout patients over the same time period.

The study concluded that gout patients have an increased risk of CVD, renal disease, and digestive system diseases, emphasizing the importance of addressing CVD risk factors in gout management. Gout has been linked to a lower dementia mortality rate, which may have implications for urate-lowering therapy and its effects on dementia risk.

According to data published in Arthritis & Rheumatology, renal disease and diseases of the digestive system also increase the risk of death for patients with gout. The researchers found that patients with gout had higher rates of metabolic and cardiovascular comorbidities, as well as chronic kidney disease.

How to Lower Your Complication Risk

• Reduce Your Stress Levels: Inflammatory arthritis flares are caused by stress, and existing symptoms worsen. Notify your support system and seek assistance with labor-intensive tasks such as grocery shopping or cleaning when you notice a possible worsening of symptoms.Reducing stress may also help you reduce sugar cravings, which might increase your risk of gout and gout attacks.
• Lose that Excess Weight: Obesity has been linked to a worsening of RA and gout symptoms. As a result, losing weight may be beneficial to your symptoms. In one study, clinically significant weight loss (more than 5 kg) was associated with improved RA disease activity in the routine clinical setting. More research is needed to back up the benefit of losing weight for gout.
• Drop that Smoking Habit: Smoking has been linked to the development of RA as well as increased and more severe RA symptoms. Quitting smoking may not only postpone but also prevent seropositive RA.
• Get Professional Treatment: Working with a reputable healthcare professional can ensure that you receive a tailored treatment plan that yields the best results.
• Get your Vaccines: It’s crucial to take precautions against infections if you have an autoimmune disease and are taking immunosuppressive medications. This includes following your healthcare provider’s advice and receiving a flu or pneumonia shot.

When Should You See a Doctor?

Arthritis does not cause death on its own, but some of the complications it causes have been linked to premature death. If you notice any new or worsening symptoms, contact your healthcare provider right away.

Gout is not curable, but it is highly treatable with medication and other appropriate treatment. Work with your doctor to reduce uric acid levels through medication, lifestyle changes, and comorbidity management.