Associations of disease activity and treatments with mortality in men with rheumatoid arthritis: results from the VARA registry

Abstract

Objectives: To examine the all-cause mortality rate and factors associated with mortality in US veteran men with RA.

Methods: Men with RA were enrolled and followed until death or censoring. Vital status was ascertained through systematic record review and standardized mortality ratios (SMRs) were calculated using US life tables for men. Multivariate Cox proportional hazards regression was used to examine the independent associations of patient factors including socio-demographics, comorbidity, measures of RA disease activity/severity and medication use with mortality. Measures of RA disease activity and medications were examined as time-varying factors.

Results: A total of 138 deaths were observed during 2314 patient-years of follow-up (n=1015 patients), corresponding to a crude morality rate of 5.9 deaths per 100 patient-years (95% CI 5.0, 7.0) and an SMR of 2.1 (95% CI 1.8, 2.5). After multivariate adjustment, factors independently associated with higher mortality risk in men with RA included older age, Caucasian race, low body weight, an increased frequency of rheumatology visits, higher ESR and RF concentrations, increased DAS28, subcutaneous nodules and prednisone use. In contrast, MTX use [hazard ratio (HR) 0.63; 95% CI 0.42, 0.96] was associated with ∼40% lower mortality risk.

Conclusion: Mortality rates among US male veterans with RA are more than twice those of age-matched men in the general population. These results suggest that optimizing disease control, particularly with regimens that include MTX and minimize glucocorticoid exposure, could improve long-term survival in this population.

Fig. 1

SMRs and 95% CIs among RA subgroups based on BMI, ESR, MTX use and prednisone use categories; factors assessed at clinical visit most proximate to time of censoring or death. ESR quartiles: ≤10, 11–21, 22–38 and ≥39 mm/h. BMI categories: <20, 20–< 25, 25–30 and >30 kg/m².