Why do people with rheumatoid arthritis still die prematurely?

Abstract

Premature death has been long recognised as a manifestation of rheumatoid arthritis (RA). Three lines of evidence can explain why patients with RA die prematurely and why the mortality gap between patients with RA and the general population appears to widening. First, patients with RA have a higher risk of several serious comorbid conditions and they tend to experience worse outcomes after the occurrence of these illnesses. Second, patients with RA do not appear to receive optimal primary or secondary preventive care. And third, the systemic inflammation and immune dysfunction associated with RA appears to promote and accelerate comorbidity and mortality. This paper provides a brief summary and interpretation of the data underlying these findings. Together, these results provide a compelling argument in favour of a focused research programme aimed specifically at eliminating premature death in patients with RA.

Figure 1. Survival Among Rochester Residents with RA first diagnosed 1955-1995, with follow-up to present day, compared to expected survival in the same underlying population

Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis Rheum 2003;48(1):54-8. Reprinted with permission of Wiley-Liss, Inc., a subsidiary of John Wiley and Sons, Inc.

Figure 2. Cumulative Incidence of Silent MI in a population-based incidence cohort of 603 RA patients and a matched non-RA comparison group of 603 non-RA subjects from the same underlying population

Increased unrecognized coronary heart disease in rheumatoid arthritis: a population-based study. Arthritis Rheum 2005;52(2)402-411. Reprinted with permission of Wiley-Liss, Inc., a subsidiary of John Wiley and Sons, Inc.

Figure 3. Cumulative Incidence of Sudden Cardiac Death in a population-based incidence cohort of 603 RA patients and a matched non-RA comparison group from the same underlying population

Increased unrecognized coronary heart disease in rheumatoid arthritis: a population-based study. Arthritis Rheum 2005;52(2)402-411. Reprinted with permission of Wiley-Liss, Inc., a subsidiary of John Wiley and Sons, Inc.

Figure 4. Distribution of EF at onset of HF

Reprinted with permission of Wiley-Liss, Inc., a subsidiary of John Wiley and Sons, Inc.

Figure 5

Trends in Comorbidities in Persons with RA vs. non-RA.

Figure 6. Six Month Mortality Following HF

Reprinted with permission of Wiley-Liss, Inc., a subsidiary of John Wiley and Sons, Inc.