Mortality Trends in Patients With Early Rheumatoid Arthritis Over 20 Years: Results From the Norfolk Arthritis Register

Abstract

ObjectiveTo examine mortality rates in UK patients with early rheumatoid arthritis (RA) from 1990–2011 and compare with population trends.MethodsThe Norfolk Arthritis Register (NOAR) recruited adults with ≥2 swollen joints for ≥4 weeks: cohort 1 (1990–1994), cohort 2 (1995–1999), and cohort 3 (2000–2004). At baseline, serum rheumatoid factor and anti–citrullinated protein antibody were measured and the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria were applied. Patients were followed for 7 years, until emigration or death. The UK Office for National Statistics notified the NOAR of the date and cause of deaths, and provided mortality rates for the Norfolk population. All-cause and cardiovascular-specific standardized mortality ratios (SMRs) were calculated. Poisson regression was used to compare mortality rate ratios (MRRs) between cohorts and then, with cubic splines, to model rates by calendar year. Analyses were performed in patients 1) with early inflammatory arthritis, 2) classified as having RA, and 3) autoantibody positive.ResultsA total of 2,517 patients were included, with 1,639 women (65%) and median age 55 years, and 1,419 (56%) fulfilled the 2010 RA criteria. All-cause and cardiovascular-specific SMRs were significantly elevated in the antibody-positive groups. There was no change in mortality rates over time after accounting for changes in the population rates. In RA patients, all-cause MRRs, compared to cohort 1, were 1.13 (95% confidence interval [95% CI] 0.84–1.52) and 1.00 (95% CI 0.70–1.43) in cohorts 2 and 3, respectively.ConclusionMortality rates were increased in patients with RA and SMRs were particularly elevated in those who were autoantibody positive. Compared to the general population, mortality rates have not improved over the past 20 years.

Smoking‐Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink

“…Patients with RA experience an approximately 1.5‐fold increased mortality compared to the general population 5, 6. The most frequent causes of premature mortality in patients with RA are CVD, malignancy, including lung cancer, severe infection, and respiratory diseases 7, 8, 9.…”

Smoking and Air Pollution as Pro-Inflammatory Triggers for the Development of Rheumatoid Arthritis

“…This strategy is underscored by the increased mortality rates in RA, due predominantly to cardiovascular and pulmonary diseases [108,109]. In this context, it is noteworthy that RA-related increased mortality has been reported to have a strong association with the combination of smoking, SE and ACPA [110].…”

According to the Materials of the 2015/2016 New European League Against Rheumatism (Eular) Guidelines for Reducing Cardiovascular Risk in Patients With Inflammatory Arthritis: General Characterization and Discussion Problems

“…Данные Норфолкского регистра подтверждают увеличение общей смертности при РА со стабильными значениями стандарти-зованного показателя смертности за последние 20 лет [11].…”