Infectious causes of death in patients with rheumatoid arthritis: an autopsy study.
OBJECTIVE
To study mortality from infections and accuracy of pre-mortem diagnoses in patients with rheumatoid arthritis (RA) autopsied during a 40-year period.


METHODS
We investigated infectious causes of death, findings at autopsy, and clinicians' estimation of cause of death in 369 consecutively autopsied RA and 371 autopsied non-RA patients with same sex, age at death, and year of autopsy. We also compiled clinical features of RA patients from medical records available and examined the association between these and infectious causes of death.


RESULTS
Deaths from any infection were more frequent in RA (36%) than in non-RA (26%) patients. In both groups, respiratory and urinary tract infections were the most common infectious causes of death. More RA patients died from urinary tract infections than non-RA patients. In approximately half of the patients in both groups, infection as a cause of death was unrecognized before death, with no major change occurring over the 40-year study period.


CONCLUSIONS
Infections, especially respiratory and urinary tract infections, are frequent causes of death in RA patients. The high proportion of undiscovered infections as a cause of death highlights the diagnostic difficulty. With a decreasing number of autopsies being performed at present, greater numbers of infections may be under-reported.
Koivuniemi
R
R
Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, FIN-00029 HUS, Helsinki, Finland. riitta.koivuniemi@hus.fi
Leirisalo-Repo
M
M
Suomalainen
R
R
Piirainen
H
H
Paimela
L
L
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000401:mortality; D002423:Cause of Death; D005260:Female; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000473:pathology; D014552:Urinary Tract Infections / Q000473:pathology