title: Mortality in rheumatoid arthritis over the last fifty years: systematic review and meta-analysis.
abstract: OBJECTIVE
  Mortality rates in patients with rheumatoid arthritis (RA) have been reported to be higher than for the general population. Fortunately, efficient therapies have reduced disease activity and may be able to diminish the excess mortality risk. This study was designed to investigate RA mortality over the last 50 years by systematic review of the literature and meta-analysis.
  
  
  METHODS
  Data to January 2010 in the Medline, Cochrane and Embase databases were searched with the keywords "rheumatoid arthritis", "epidemiologic methods" and "mortality". Inclusion criteria were (i) longitudinal study, (ii) early RA patients, (iii) number of deaths and mean patient follow-up. Incidence mortality rates (IMR) were calculated and standardized mortality rates (SMR) were extracted when available. A meta-analysis by periods of inclusion and a Poisson regression were used to model IMR. Available SMR were computed as a meta-analysis.
  
  
  RESULTS
  A total of 11 longitudinal studies starting from 1955 to 1995, representing 51,819 patients, met the inclusion criteria. Mean IMR was 2.7/100 person-years of follow-up (95% confidence interval [CI]: 2.2, 3.3) and ranged from 1.0 to 5.2/100 person-years. A decreasing IMR was found in the meta-analyses. Poisson regression analysis indicated a decrease in IMR of 2.3% per year (95%CI: 2.1; 2.6). SMR was available in 8 studies: the meta-SMR was 1.47 (95%CI: 1.19; 1.83) and no decrease was seen over time in the meta-regression.
  
  
  CONCLUSIONS
  Mortality has decreased among RA patients over the past decades but remained higher than in the general population as assessed by the IMR and the SMR over time.
authors.affiliation: Rheumatology Department, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France. sabrinadadoun@gmail.com
authors.forename: Sabrina
authors.initials: S
authors.lastname: Dadoun
authors.forename: Nadine
authors.initials: N
authors.lastname: Zeboulon-Ktorza
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
authors.forename: Muriel
authors.initials: M
authors.lastname: Elhai
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rozenberg
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
mesh_terms: D001172:Arthritis, Rheumatoid / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends