Rheumatology Advance Access originally published online on August 14, 2006
Rheumatology 2007 46(2):350-357; doi:10.1093/rheumatology/kel253
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Mortality in rheumatoid arthritis. Increased in the early course of disease, in ischaemic heart disease and in pulmonary fibrosis
1ERAS, Department of Rheumatology, City Hospital, St Albans and 2Department of Statistics, University of Hertfordshire, Hertfordshire, UK.
Correspondence to: Dr A. Young, Rheumatology Department, City Hospital, St Albans, Hertfordshire AL3 5PN, UK. E-mail: eras{at}whht.nhs.uk
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Abstract |
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Objective. To examine the cause of death in a large UK inception cohort of rheumatoid arthritis (RA), and whether this was related to disease duration and severity, treatment effects or extra-articular features and complications of RA.
Methods. Standard clinical, laboratory, radiological and socio-economic measures were recorded at baseline and yearly in an inception cohort started in nine centres in 1986. Date and the cause of death were based on death certificates and the comparisons made with age and sex matched population figures. Risk factors for mortality were identified from baseline measures of disease.
Results. There were 459 deaths (32%) in 1429 patients followed for up to 18 yrs. Standard mortality ratio was 1.27. Survival was significantly lower in the first 7 yrs of RA. Excess mortality was seen in cardiovascular disease (31%), pulmonary fibrosis (4%) and lymphoma (2.3%). Baseline predictors for mortality were men, older age, poor function, lower socio-economic status, extra-articular features, comorbidity, rheumatoid factor, X-ray erosions, high-ESR and low-haemoglobin.
Conclusion. There was a modest increase in mortality in RA, mainly in the first 7 yrs. Deaths from cardiovascular disease and pulmonary fibrosis were higher than expected, but treatment-related deaths were low. Risk factors included less favourable socio-economic status, markers of disease severity and diminished function within the first year.
KEY WORDS: Rheumatoid arthritis, Mortality, Cardiovascular disease, Pulmonary fibrosis, Function
Submitted 10 April 2006;
revised version accepted 25 May 2006.
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