Mortality in rheumatoid arthritis. Increased in the early course of disease, in ischaemic heart disease and in pulmonary fibrosis.
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.


CONCLUSIONS
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.
Young
A
A
Department of Rheumatology, City Hospital, St Albans, Hertfordshire AL3 5PN, UK. eras@whht.nhs.uk
Koduri
G
G
Batley
M
M
Kulinskaya
E
E
Gough
A
A
Norton
S
S
Dixey
J
J
D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D002423:Cause of Death; D004739:England / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology* / Q000401:mortality; D011658:Pulmonary Fibrosis / Q000209:etiology* / Q000401:mortality; D012737:Sex Factors; D014657:Vasculitis / Q000209:etiology / Q000401:mortality
D018501:Antirheumatic Agents