Response to methotrexate treatment is associated with reduced mortality in patients with severe rheumatoid arthritis

Krause, D.; B, Schleusser; Herborn, G.; Rau, Rolf

doi:10.1002/1529-0131(200001)43:1<14::aid-anr3>3.0.co;2-7

Cited by 189 publications

(92 citation statements)

References 29 publications

(22 reference statements)

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“…However, this statement has been questioned and the diverging results are thought to be due to different study designs (15). Treatment with MTX was found to reduce mortality in patients with RA (16,17). As MTX was not commonly used during the first 5-10 years of the present study, we could not perform a corresponding analysis.…”

Section: Discussionmentioning

confidence: 80%

“…Krause et al (16) found that a sufficient response to methotrexate (MTX) treatment was associated with decreased mortality in patients with severe RA, although the mortality rate remained only modestly increased compared to that in patients with severe RA not responding to MTX (SMR 1.64 vs. 4.11, respectively). MTX has also been shown to provide a survival benefit largely by reducing cardiovascular mortality (17).…”

mentioning

confidence: 99%

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Long-term mortality rate in rheumatoid arthritis patients with disease onset in the 1980s

Kapetanovic

Lindqvist

Geborek

et al. 2011

Scandinavian Journal of Rheumatology

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Objective: To investigate the mortality rate and possible early predictive factors of mortality after 19-23 years in a cohort of patients with rheumatoid arthritis (RA) followed prospectively from disease onset. Patients and methods:A community-based cohort of 183 patients (63% female) with RA and disease duration < 2 years was recruited [1985][1986][1987][1988][1989]. The patients were followed yearly from diagnosis until death or 31 December 2008. Mean age and mean duration of symptoms (range) at diagnosis were 52 (18-78) years and 11 (0-24) months, respectively. Death certificates were obtained from the Swedish Cause of Death Register and causes of death coded by the International Classification of Diseases (ICD-10). Death rates of RA patients were compared to those of age-and sex-matched controls. Possible predictors of mortality were analysed using a Cox regression model. Results:By 31 December 2008, 69 patients (37 women and 32 men) had died. The standardized mortality ratio (SMR) was 1.23 [95% confidence interval (CI) 0.97-1.55] and p < 0.09. Older age, male sex, smoking, and the presence of cardiovascular disease (CVD) at RA diagnosis were identified as early predictors of mortality. CVD was the most common cause of death (46%), followed by malignancies (29%) and infections (13%). RA was not stated as the direct cause of death in any patient and was mentioned among underlying causes in only 16/69 (23%) patients. Conclusion:Mortality rate after 19-23 years of disease duration in this cohort of patients with disease onset in the 1980s was not significantly increased compared to age-and sexmatched controls. No RA disease-related factor predicted mortality.Rheumatoid arthritis (RA) is a chronic inflammatory disease commonly associated with joint destruction, disability, and increased co-morbidity. The issue of premature mortality in patients with RA has been addressed in numerous studies. The first study reporting an increased mortality in patients with RA compared to controls was published in 1953 (1), and was followed by several reports confirming these findings (2-9). In recent decades the approach to treatment of RA and treatment strategies in RA has changed dramatically. Early treatment with disease-modifying anti-rheumatic drugs (DMARDs) and the availability of biological remedies have led to better control of disease activity and decreased disability (10)(11)(12)(13)(14). However, in a population-based analysis of trends over four decades published in 2003, an increased mortality rate [standardized mortality ratio (SMR) of 1.27] in RA patients was found (6). Overall mortality in the general population was shown to decrease over 4-5 decades but mortality rates in RA remained relatively constant, resulting in a widening of the mortality gap (7). A recently published review of > 200 studies on mortality in RA reported lower SMRs in studies of inception cohorts compared to non-inception cohorts over 60 years (median SMRs of 1.2-1.3 and 1.6-1.7, respectively) (15). Krause et al (16) found that a sufficien...

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Section: Discussionmentioning

confidence: 80%

mentioning

confidence: 99%

Long-term mortality rate in rheumatoid arthritis patients with disease onset in the 1980s

Kapetanovic

Lindqvist

Geborek

et al. 2011

Scandinavian Journal of Rheumatology

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“…In addition, it was recently demonstrated that a response to MTX was related to reduced mortality in patients with severe RA. 35 Because we could assume we had collected most of the cases of lymphoma appearing in RA patients treated with MTX in France, we estimated the annual incidence of NHL in these patients (16.7 ϫ 10 Ϫ5 in women and 33.3 ϫ 10 Ϫ5 in men). No significant increased risk of NHL with the French NHL incidence was observed, 23 with an SMR close to 1, after adjustment for sex and age.…”

Section: Discussionmentioning

confidence: 99%

Lymphomas in rheumatoid arthritis patients treated with methotrexate: a 3-year prospective study in France

Mariette

Cazals–Hatem²,

Warszawki³

et al. 2002

Blood

389

230

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-1.7). The estimated annual incidence rate of HD among men and women was, respectively, 27.8.10 ؊5 (0-70.1) and 2.8.10 ؊5 (0-9.6). The incidence of HD was significantly increased compared with the French incidence, with an SMR adjusted for age and sex of 7.4 (3.0-15.3; P < .001). Thus, this 3-year prospective study indicated that, whereas the risk of NHL was not significantly increased in RA patients treated with MTX, the incidence of HD appeared to be higher in these patients compared to the French population.

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“…It appears likely that improved physical function would be associated with improved survival, based on pioneering studies of improved mortality outcomes associated with methotrexate treatment by Krause 46 and Choi 47 , as well as with biologic agents by Jacobsson 48 . Improvement in physical function scores with these agents is well established.…”

Section: Rheumatologymentioning

confidence: 99%

Documenting the Value of Care for Rheumatoid Arthritis, Analogous to Hypertension, Diabetes, and Hyperlipidemia: Is Control of Individual Patient Self-Report Measures of Global Estimate and Physical Function More Valuable Than Laboratory Tests, Radiographs, Indices, or Remission Criteria?

2013

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Response to methotrexate treatment is associated with reduced mortality in patients with severe rheumatoid arthritis

Abstract: Patients with severe RA who do not respond to MTX treatment have a poor prognosis, with >4-fold increased mortality compared with the general population, while RA patients who respond to MTX treatment have only a moderately increased mortality rate.

Cited by 189 publications

References 29 publications

Long-term mortality rate in rheumatoid arthritis patients with disease onset in the 1980s

Long-term mortality rate in rheumatoid arthritis patients with disease onset in the 1980s

Lymphomas in rheumatoid arthritis patients treated with methotrexate: a 3-year prospective study in France

Documenting the Value of Care for Rheumatoid Arthritis, Analogous to Hypertension, Diabetes, and Hyperlipidemia: Is Control of Individual Patient Self-Report Measures of Global Estimate and Physical Function More Valuable Than Laboratory Tests, Radiographs, Indices, or Remission Criteria?

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