Causes of death in patients with rheumatoid arthritis autopsied during a 40-year period.
We studied causes of death (CoDs) between 1952 and 1991 assessed by a clinician before autopsy and then determined at autopsy by a pathologist in 369 subjects with rheumatoid arthritis (RA) and 370 subjects without RA (non-RA). We analysed clinical data for RA subjects between 1973 and 1991. In RA subjects, leading autopsy-based CoDs were RA, cardiovascular diseases and infections. Between diagnoses of CoDs by the clinician and those determined by the pathologist, RA subjects had lower agreement than did the non-RA regarding coronary deaths (Kappa reliability measure: 0.33 vs. 0.46). In non-RA subjects, autopsy-based coronary deaths showed a decline since the 1970s with no such decline in RA. Between subjects treated at any time during RA with disease-modifying anti-rheumatic drugs and those without, autopsy-based CoDs were similar. Coronary death being less accurately diagnosed in RA subjects may indicate that coronary heart disease in RA patients often remains unrecognized.
Koivuniemi
R
R
Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, PO BOX 263, 00029 HUS, Helsinki, Finland. riitta.koivuniemi@hus.fi
Paimela
L
L
Suomalainen
R
R
Piirainen
H
H
Karesoja
M
M
Helve
T
T
Leirisalo-Repo
M
M
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000401:mortality*; D001344:Autopsy; D016022:Case-Control Studies; D002423:Cause of Death / Q000639:trends; D003327:Coronary Disease / Q000401:mortality*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries