The Increased Mortality Risk in People With Osteoarthritis

Osteoarthritis and mortality have not been extensively studied, nor discussed. Mostly, osteoarthritis is associated with joint pain, physical disability, and functional limitations. It is usually rheumatoid arthritis, not osteoarthritis, that is connected to increased mortality and reduced life expectancy. That said, collectively, rheumatic diseases are not considered fatal or terminal.

The History of Research on the Link

In 2008, Hochberg published results from a systematic review of studies that considered mortality and survival in people with osteoarthritis. He reported on seven studies which met the inclusion criteria:

• The first U.S. study of osteoarthritis and mortality was published in 1976. Patients admitted to the hospital for bed rest and physical therapy were compared to the general population. For the first 10 years after hospitalization, survival rates for males and females were similar to the general population but dropped lower after that. Arteriosclerotic heart disease was the most common cause of death, causing 40 percent of deaths. Gastrointestinal problems, accounting for 6 percent of all deaths among those with osteoarthritis, were at twice the rate of the general population. Aspirin usage was said to be associated with gastrointestinal causes of death in the osteoarthritis group.
• The second U.S. study in 1989 evaluated mortality in people with X-ray evidence of knee osteoarthritis compared to people without X-ray evidence of knee osteoarthritis. Results revealed excess mortality that was statistically significant in women only who had X-ray evidence of knee osteoarthritis.
• Cerhan in the U.S. in 1995 assessed mortality in a cohort of women who worked in the radium dial-painting industry. In women classified as having low radium exposure, 55 joints were graded for the degree of osteoarthritis. Osteoarthritis of the hands, both knees, and cervical spine were associated with reduced survival or increase mortality. Interestingly, osteoarthritis of the hips, feet, or lumbar spine was not. Researchers concluded that decreased physical activity or medication use may contribute.
• Watson studied vascular events in osteoarthritis patients in 2003. They also considered people with rheumatoid arthritis and people aged 40 and over without arthritis. No statistical differences were found pertaining to vascular death and sudden death in the three groups. However, it was noted that there were limitations to the data used.
• A Finnish study, in 2003 and 2004, looked into the association between osteoarthritis of the finger joints and carpometacarpal joint of the thumb and mortality. Women with symmetrical osteoarthritis involving the DIP joint (distal interphalangeal) had an increased risk of mortality. But, that was not the case with women who had osteoarthritis in any random finger joint or men with osteoarthritis in any finger or symmetrical DIP osteoarthritis. Osteoarthritis of the carpometacarpal joint of the thumb also was not associated with an increased risk of mortality.
• A study in the UK in 2007 evaluated all-cause mortality and mortality related to ischemic heart disease and malignancy in people with rheumatoid arthritis, their same-sex siblings, and people with lower limb osteoarthritis. The osteoarthritis group had an increased risk of mortality from ischemic heart disease, but not from malignancy. Researchers concluded that ischemic heart disease may be related to decreased physical activity and NSAID (nonsteroidal anti-inflammatory drug) use.

Knee Osteoarthritis and Increased Risk of Mortality

British researchers in 2015 analyzed data from the Chingford Study to assess early mortality in middle-aged women with osteoarthritis. They determined that knee osteoarthritis was strongly associated with early all-cause mortality and cardiovascular mortality. In fact, women with knee pain and X-ray evidence of osteoarthritis had twice the risk of early death and more than three times the risk of cardiovascular death compared to women without knee pain or evidence of osteoarthritis. They found no link between hand osteoarthritis and increased risk of mortality.

In 2014, Cleveland RJ et al. published study results in Osteoarthritis and Cartilage which revealed that severe knee osteoarthritis (both symptomatic and radiographic knee osteoarthritis) was associated with an increased risk of death. This was the case even after adjusting for smoking, body size, and certain comorbidities. Researchers suggested that this points to systemic effects for large joint radiographic osteoarthritis, as well as symptomatic osteoarthritis.

A Word From Verywell

Osteoarthritis and mortality is not a well-studied disease consequence. But, enough has been done to suggest that osteoarthritis in certain joints, especially the large joints, may be linked to a higher risk of mortality.

If we are to understand whether that is due to systemic effects of osteoarthritis versus consequences of disability, limited physical activity, medication use, or lifestyle, more high-quality studies are needed. At this point, there is moderate evidence available.