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. 2008 Jun;35(6):1009-14.
Epub 2008 Apr 15.

Mortality trends in rheumatoid arthritis: the role of rheumatoid factor

Angel Gonzalez  1 , Murat Icen, Hilal Maradit Kremers, Cynthia S Crowson, John M Davis 3rd, Terry M Therneau, Veronique L Roger, Sherine E Gabriel
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Mortality trends in rheumatoid arthritis: the role of rheumatoid factor

Angel Gonzalez et al. J Rheumatol. 2008 Jun.

Abstract

Objective: We previously demonstrated a widening in the mortality gap between subjects with rheumatoid arthritis (RA) and the general population. We examined the contribution of rheumatoid factor (RF) positivity on overall mortality trends and cause-specific mortality.

Methods: A population-based RA incidence cohort (1955-1995, and aged >or= 18 yrs) was followed longitudinally until death or January 1, 2006. The underlying cause of death as coded from national mortality statistics and grouped according to ICD-9/10 chapters was used to define cause-specific mortality. Expected cause-specific mortality rates were estimated by applying the age-, sex-, and calendar-year-specific mortality rates from the general population to the RA cohort. Poisson regression was used to model the observed overall and cause-specific mortality rates according to RF status, accounting for age, sex, disease duration, and calendar year.

Results: A cohort of 603 subjects (73% female; mean age 58 yrs) with RA was followed for a mean of 16 years, during which 398 died. Estimated survival at 30 years after RA incidence was 26.0% in RF+ RA subjects compared to 36.0% expected (p < 0.001), while in RF- RA subjects, estimated survival was 29.1% compared to 28.3% expected (p = 0.9). The difference between the observed and the expected mortality in the RF+ RA subjects increased over time, resulting in a widening of the mortality gap, while among RF- RA subjects, observed mortality was very similar to the expected mortality over the entire time period. Among RF+ RA subjects, cause-specific mortality was higher than expected for cardiovascular [relative risk (RR) 1.50; 95% confidence interval (CI) 1.22, 1.83] and respiratory diseases [RR 3.49; 95% CI 2.51, 4.72]. Among RF- RA subjects, no significant differences were found between observed and expected cause-specific mortality.

Conclusion: The widening in the mortality gap between RA subjects and the general population is confined to RF+ RA subjects and largely driven by cardiovascular and respiratory deaths.

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Figures

Figure 1
Figure 1
Observed survival in rheumatoid factor positive rheumatoid arthritis (RF+ RA) (Figure 1a) and RF− RA (Figure 1b) subjects compared with expected survival based on the Minnesota white population.
Figure 2
Figure 2
Observed and expected mortality in rheumatoid factor positive (RF+) and rheumatoid factor negative (RF−) rheumatoid arthritis (RA) subjects
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