The mortality of rheumatoid arthritis.

OBJECTIVE To determine the risk and causes of death and to quantify mortality predictors in patients with rheumatoid arthritis (RA). METHODS RA patients (n = 3,501) from 4 centers (Saskatoon n = 905, Wichita n = 1,405, Stanford n = 886, and Santa Clara n = 305) were followed for up to 35 years; 922 patients died. RESULTS The overall standardized mortality ratio (SMR) was 2.26 (Saskatoon 2.24, Wichita 1.98, Stanford 3.08, Santa Clara 2.18) and increased with time. Mortality was strikingly increased for specific causes: infection, lymphoproliferative malignancy, gastroenterologic, and RA. In addition, as an effect of the SMR of 2.26, the expected number of deaths was increased nonspecifically across all causes (except cancer), with a large excess of deaths attributable to cardiovascular and cerebrovascular diseases. Independent predictors of mortality included age, education, male sex, function, rheumatoid factor, nodules, erythrocyte sedimentation rate, joint count, and prednisone use. CONCLUSION Mortality rates are increased at least 2-fold in RA, and are linked to clinical severity.

[1]  S. Cobb,et al.  Length of life and cause of death in rheumatoid arthritis. , 1953, The New England journal of medicine.

[2]  G. A. Bennett,et al.  1958 REVISION of diagnostic criteria for rheumatoid arthritis. , 1959, Arthritis and rheumatism.

[3]  J. Duthie,et al.  Course and Prognosis in Rheumatoid Arthritis , 1964, Annals of the rheumatic diseases.

[4]  G. Moesmann.  Malignancy and mortality in subacute rheumatoid arthritis in old age. , 1969, Acta rheumatologica Scandinavica.

[5]  H. G. Kelly,et al.  Survivorship and death in rheumatoid arthritis. , 1970, Arthritis and rheumatism.

[6]  H. Isomäki,et al.  Death rate and causes of death in patients with rheumatoid arthritis. , 1975, Scandinavian journal of rheumatology.

[7]  R. Monson,et al.  Mortality among arthritics. , 1976, Journal of chronic diseases.

[8]  Do You Die from Rheumatism? , 1976, Scandinavian journal of social medicine.

[9]  H. Isomäki,et al.  Death rate and causes of death in RA patients during a period of five years. , 1977, Scandinavian journal of rheumatology.

[10]  R. Hanka,et al.  Cause of death in patients with rheumatoid arthritis with particular reference to azathioprine. , 1980, Annals of the rheumatic diseases.

[11]  A. Linos,et al.  The epidemiology of rheumatoid arthritis in Rochester, Minnesota: a study of incidence, prevalence, and mortality. , 1980, American journal of epidemiology.

[12]  P. Allebeck,et al.  Increased mortality among persons with rheumatoid arthritis, but where RA does not appear on death certificate. Eleven-year follow-up of an epidemiological study. , 1981, Scandinavian journal of rheumatology.

[13]  J. Abruzzo.  Rheumatoid arthritis and mortality. , 1982, Arthritis and rheumatism.

[14]  P. Allebeck.  Increased Mortality in Rheumatoid Arthritis: The Use of a Medical Information System for Assessment of Death Risks , 1982 .

[15]  S. Sarna,et al.  Prognosis of inflammatory joint diseases. A three-year follow-up study. , 1983, Scandinavian journal of rheumatology.

[16]  D. Symmons,et al.  Cause of death in rheumatoid arthritis. , 1984, British journal of rheumatology.

[17]  A. Cats,et al.  Survival and cause of death in rheumatoid arthritis: a 25-year prospective followup. , 1984, The Journal of rheumatology.

[18]  T. Pincus,et al.  Severe functional declines, work disability, and increased mortality in seventy-five rheumatoid arthritis patients studied over nine years. , 1984, Arthritis and rheumatism.

[19]  K. Kaarela.  Prognostic factors and diagnostic criteria in early rheumatoid arthritis. , 1985, Scandinavian journal of rheumatology. Supplement.

[20]  M. Laakso,et al.  Ten year mortality and causes of death in patients with rheumatoid arthritis. , 1985, British medical journal.

[21]  D. Symmons,et al.  Factors influencing mortality in rheumatoid arthritis. , 1986, Journal of chronic diseases.

[22]  J. Fries,et al.  Survival, prognosis, and causes of death in rheumatoid arthritis. , 1986, Arthritis and rheumatism.

[23]  M. Laakso,et al.  Mortality from amyloidosis and renal diseases in patients with rheumatoid arthritis. , 1986, Annals of the rheumatic diseases.

[24]  R. Day,et al.  The oncogenicity of chlorambucil in rheumatoid arthritis. , 1988, British journal of rheumatology.

[25]  D. Symmons.  Mortality in rheumatoid arthritis. , 1988, British journal of rheumatology.

[26]  CELL GROWTH AND ACTIVATION , 1988 .

[27]  M. Liang,et al.  The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. , 1988, Arthritis and rheumatism.

[28]  P. Venables,et al.  Factors predicting a poor life prognosis in rheumatoid arthritis: an eight year prospective study. , 1989, Annals of the rheumatic diseases.

[29]  A. Silman,et al.  Mortality and survival in rheumatoid arthritis: a 25 year prospective study of 100 patients. , 1990, Annals of the rheumatic diseases.

[30]  F. Wolfe,et al.  The latex test revisited. Rheumatoid factor testing in 8,287 rheumatic disease patients. , 1991, Arthritis and rheumatism.

[31]  J. Fries,et al.  Mortality predictors among 263 patients with rheumatoid arthritis. , 1991, The Journal of rheumatology.

[32]  F. Wolfe,et al.  The assessment and prediction of functional disability in rheumatoid arthritis. , 1991, The Journal of rheumatology.

[33]  S. Pillemer,et al.  Rheumatoid arthritis and mortality. A longitudinal study in Pima Indians. , 1993, Arthritis and rheumatism.