Objective. To investigate mortality rates, causes of death, time trends in mortality, prognostic factors for mortality, and the relationship between disease activity and mortality over a 23-year period in an inception cohort of rheumatoid arthritis (RA) patients.

Anti-TNFalpha therapy significantly reduced disease activity in all age groups of patients; however, it appeared less effective in elderly compared with younger RA patients.

Patients with RA who developed MI had more classical risk factors but not higher disease activity over time than control patients with RA. Low levels of inflammation may be sufficient for accelerated atherogenesis and an excess risk of cardiovascular disease in RA.

Elderly RA patients were less likely to receive anti-TNF-alpha treatment within an equal period of time compared with younger patients, taking disease activity, disease duration and comorbidities into account.