When the sad news about the passing of Glenn Frey hit the Internet Monday night, there were varying reports about the precise cause of the Eagles guitarist and singer’s death.
A post on the band’s website stated Frey had “succumbed to complications from rheumatoid arthritis, acute ulcerative colitis and pneumonia.” And in an interview with the entertainment and media news website TheWrap, Eagles manager Irving Azoff said Frey’s death could be blamed in part on the RA medications he was taking. (There have been no public reports about which medications Frey was taking.)
“The colitis and pneumonia were side effects from all the meds,” Azoff told TheWrap. “He died from complications of [ulcerative] colitis after being treated with drugs for his rheumatoid arthritis, which he had for over 15 years.”
While it is impossible to know, without consulting Frey’s doctors, what was the actual cause of his death – or which disease came first – Frey reportedly had had RA for 15 years and his intestinal problems date back at least 30 years to 1986, when, The Washington Post reports, he missed a benefit concert in California because of “an intestinal disorder.” Eight years later, the Eagles’ “Hell Freezes Over” reunion tour was interrupted by Frey’s “bout with diverticulitis.” In October 1994, People magazine reported that Frey was recuperating at his home in Los Angeles following surgery earlier that month for diverticulitis, “an inflammation of the colon.”
Arthritis experts not involved in Frey’s care say it is unlikely that RA directly caused his death, or that the medications he took for RA somehow caused ulcerative colitis, a chronic autoimmune disease that causes ulcers and inflammation in the inner lining of the colon and rectum. However, some forms of inflammatory arthritis are accompanied by bowel disease, and the treatments for RA and ulcerative colitis overlap, says David Pisetsky, MD, PhD, professor of medicine and immunology at Duke University Medical Center in Durham, N.C. A number of drugs, including TNF inhibitors, sulfasalazine, azathioprine, methotrexate and corticosteroids, are used in the treatment of both RA and ulcerative colitis. These drugs work largely by suppressing the immune response that causes damage in the two diseases.
While current RA treatments greatly improve the quality of life, reduce permanent joint damage and perhaps extend the life expectancy for people with RA, they are not trivial drugs, says Eric Matteson, MD, a rheumatologist at the Mayo Clinic in Rochester, Minn. They can have serious side effects. For example, by suppressing the immune response that causes tissue damage, they also increase susceptibility to infections, including pneumonia.
“People with RA already have a two-fold risk of infection,” says Dr. Matteson. Infection risk also increases with age (Frey was 67) and with hospitalization and surgery. Frey reportedly had a relapse of intestinal issues which forced the Eagles to cancel their Kennedy Center Honors appearance in December. “At the time, the band said he needed major surgery that would require a lengthy recovery,” TMZ reported. Dr. Matteson says any or all of these factors could have contributed to pneumonia.
It is no secret that many patients are very concerned over medication side effects, especially when hearing about Frey’s death. But rather than focusing on the harm the medicines might have caused, Dr. Matteson considers what Frey’s life with RA would have been like without the medicines. “Would he have had those 15 productive years? We have no way of knowing.”
Dr. Matteson says even if Frey’s death was not directly related to RA, his story sends a message of how serious RA can be. In addition to infection risk, people with RA also have increased risk of other health problems, most notably cardiovascular disease, lung problems and certain cancers. And while life expectancy for someone with RA has improved over the last 20 years, it’s still lower than that of a person in the general population.
Appropriate treatment and monitoring are crucial for people with RA, as is keeping up to date on immunizations and taking medications at the lowest doses necessary to control the disease, says Dr. Pisetsky. Weighing the risks and benefits should be part of the discussion between a doctor and patient before starting (or ending) any treatment.
Author: Mary Anne Dunkin for the Arthritis Foundation