No increased mortality in patients with rheumatoid arthritis: up to 10 years of follow up from disease onset

Abstract

Objective-To investigate mortality, functional capacity, and prognostic factors for mortality in an inception cohort of patients with recently diagnosed RA followed up for up to 10 years. Methods-The observed mortality of this inception cohort with recently diagnosed RA, was analysed in relation to the expected mortality, calculated with the aid of life tables of the general population of the Netherlands (matched for age and sex). Functional capacity was measured by the Health Assessment Questionnaire. Prognostic factors for mortality were analysed multivariately by the Cox proportional hazards model. Results-Between January 1985 and April 1997, 622 patients entered the study, and were included in the analysis of mortality. The death rate in the first 10 years of the disease was not significantly diVerent from that of the general population. Fifty five patients from the study group died (16% up to 10 years of follow up). The most commonly reported causes of death were of cardiovascular and respiratory origin. The other causes of death could be classified into cancer, sepsis, amyloidosis, leukaemia, renal insuYciency of unknown cause, perforation of the oesophagus, probably related to the treatment with non-steroidal anti-inflammatory drugs, and pancytopenia during aurothioglucose treatment. Functional capacity improved significantly during the first six years compared with the value at start. Statistically significant predictors for death were age at the start and male sex. Conclusions-In contrast with earlier studies performed, no excess mortality in the first 10 years of an inception cohort of patients with RA was seen. In addition, the functional capacity was relatively constant during the first six years after an initial improvement from baseline. Age at start and male sex were the only statistically significant predictors for death. (Ann Rheum Dis 2000;59:954-958)

The good initial response to therapy with a combination of traditional disease‐modifying antirheumatic drugs is sustained over time: The eleven‐year results of the Finnish rheumatoid arthritis combination therapy trial

“…Also, the observed mortality rate was equal to that in the general population. This finding is consistent with those of some previous studies (30,31).…”

Lack of cardiovascular risk assessment in inflammatory arthritis and systemic lupus erythematosus patients at a tertiary care center

“…While IA patients are treated with disease modifying anti-rheumatic drugs (DMARDs) and biologic agents that reduce disease activity, multiple studies have demonstrated increased cardiovascular (CV) risk despite conventional anti-rheumatic therapy [4][5][6][7]. Several studies of rheumatoid arthritis (RA) patients with disease durations of less than 5 years demonstrated an increased CV risk, suggesting this excess risk is an early feature of RA [4,[8][9][10][11]. The risk appears to accumulate over time and persists after adjustment for other cardiovascular risk factors (relative risk of MI is greater than three after 10 years of having the disease) [6,12] suggesting that RA independently doubles the hazard for myocardial infarction and sudden cardiac death.…”

Lack of evidence for association of two functional SNPs of CHI3L1 gene (HC-gp39) with rheumatoid arthritis

“…Three further RA risk loci have been identified recently, including the STAT4 gene [7][8][9], loci in the 6q23 [10][11] and TRAF1/C5 [12][13]. As RA is a major cause of disability and is even correlated with increased mortality in severe cases [14]. Identification of genetic risk factors of RA may help to understand basic mechanisms of autoimmunity and may be helpful in the development of targeted diagnostics and therapeutics.…”