The mortality of rheumatoid arthritis.
OBJECTIVE
To determine the risk and causes of death and to quantify mortality predictors in patients with rheumatoid arthritis (RA).


METHODS
RA patients (n = 3,501) from 4 centers (Saskatoon n = 905, Wichita n = 1,405, Stanford n = 886, and Santa Clara n = 305) were followed for up to 35 years; 922 patients died.


RESULTS
The overall standardized mortality ratio (SMR) was 2.26 (Saskatoon 2.24, Wichita 1.98, Stanford 3.08, Santa Clara 2.18) and increased with time. Mortality was strikingly increased for specific causes: infection, lymphoproliferative malignancy, gastroenterologic, and RA. In addition, as an effect of the SMR of 2.26, the expected number of deaths was increased nonspecifically across all causes (except cancer), with a large excess of deaths attributable to cardiovascular and cerebrovascular diseases. Independent predictors of mortality included age, education, male sex, function, rheumatoid factor, nodules, erythrocyte sedimentation rate, joint count, and prednisone use.


CONCLUSIONS
Mortality rates are increased at least 2-fold in RA, and are linked to clinical severity.
Wolfe
F
F
University of Kansas School of Medicine, Wichita.
Mitchell
D M
DM
Sibley
J T
JT
Fries
J F
JF
Bloch
D A
DA
Williams
C A
CA
Spitz
P W
PW
Haga
M
M
Kleinheksel
S M
SM
Cathey
M A
MA
D001172:Arthritis, Rheumatoid / Q000401:mortality*; D002140:California / Q000453:epidemiology; D002423:Cause of Death; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012525:Saskatchewan / Q000453:epidemiology; D015996:Survival Rate