The mortality of rheumatoid arthritis

TLDR

The study aimed to quantify mortality risk, causes of death, and predictors in rheumatoid arthritis patients. The authors followed 3,501 RA patients from four centers over up to 35 years, during which 922 deaths occurred. The standardized mortality ratio was 2.26 and increased over time, with markedly higher deaths from infection, lymphoproliferative malignancy, gastroenterologic, RA, and excess cardiovascular and cerebrovascular mortality; predictors included age, education, male sex, function, rheumatoid factor, nodules, ESR, joint count, and prednisone use. The abstract contains sections on objective, methods, and results.

Abstract

Abstract Objective . To determine the risk and causes of death and to quantify mortality predictors in patients with rheumatoid arthritis (RA). Methods . RA patients (n = 3,501) from 4 centers (Saskatoon n = 905, Wichita n = 1,405, Stanford n = 886, and Santa Clara n = 305) were followed for up to 35 years; 922 patients died. Results . The overall standardized mortality ratio (SMR) was 2.26 (Saskatoon 2.24, Wichita 1.98, Stanford 3.08, Santa Clara 2.18) and increased with time. Mortality was strikingly increased for specific causes: infection, lymphoproliferative malignancy, gastroenterologic, and RA. In addition, as an effect of the SMR of 2.26, the expected number of deaths was increased nonspecifically across all causes (except cancer), with a large excess of deaths attributable to cardiovascular and cerebrovascular diseases. Independent predictors of mortality included age, education, male sex, function, rheumatoid factor, nodules, erythrocyte sedimentation rate, joint count, and prednisone use.