title: Determinants of mortality among postmenopausal women in the women's health initiative who report rheumatoid arthritis.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) patients have an increased risk of cardiovascular disease (CVD) and mortality. We measured anti-cyclic citrullinated peptide (anti-CCP) antibody levels and determined use of disease-modifying antirheumatic drugs (DMARDs) among women in the Women's Health Initiative (WHI). Using these data, we undertook this study to assess total mortality over 10 years of followup among white, black, or Hispanic women with self-reported RA in the WHI.
  
  
  METHODS
  Using stored baseline serum, we measured anti-CCP, rheumatoid factor (RF), and antinuclear antibodies (ANAs) in 9,988 women who reported having RA. Based on a previous chart review study, probable RA was defined as either self-reported RA and anti-CCP positivity, or anti-CCP negativity and DMARD use. Cox proportional hazards regression was used to model the relationship of self-reported RA, DMARD exposure, and anti-CCP positivity to total mortality, using followup data through April 2009.
  
  
  RESULTS
  At baseline, the mean age was 62.8 years; 24.5% of subjects were black and 10% were Hispanic. Prevalence of anti-CCP positivity was 8.1% (n = 812), and 217 women were anti-CCP negative but had reported use of DMARDs; therefore, 1,029 women (of 9,988) were classified as having probable RA, and 8,958 were classified as unlikely to have RA (with data on DMARD use missing for 1 subject). Age-adjusted mortality rates were ∼2-fold higher for anti-CCP-positive women, with 20.2 deaths per 1,000 person-years, as compared to 11.4 deaths per 1,000 person-years among anti-CCP-negative women with self-reported RA who never used DMARDs. Among women who did not report any arthritis at baseline, we found 8.3 deaths per 1,000 person-years. The increased risk among anti-CCP-positive women with RA was not explained by age, RF positivity, ANA positivity, or DMARD use.
  
  
  CONCLUSIONS
  Anti-CCP-positive RA was associated with substantial excess mortality among postmenopausal women in the WHI. This result was not explained by the risk factors we measured.
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Mackey
authors.forename: Brian T
authors.initials: BT
authors.lastname: Walitt
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Deane
authors.forename: V Michael
authors.initials: VM
authors.lastname: Holers
authors.forename: William H
authors.initials: WH
authors.lastname: Robinson
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sokolove
authors.forename: Yuefang
authors.initials: Y
authors.lastname: Chang
authors.forename: Simin
authors.initials: S
authors.lastname: Liu
authors.forename: Christine G
authors.initials: CG
authors.lastname: Parks
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Wright
authors.forename: Larry W
authors.initials: LW
authors.lastname: Moreland
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D017698:Postmenopause / Q000097:blood*; D012217:Rheumatoid Factor / Q000097:blood; D012720:Severity of Illness Index; D016387:Women's Health
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor