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. 2014 Sep;66(9):1296-301.
doi: 10.1002/acr.22296.

Mortality trends in patients with early rheumatoid arthritis over 20 years: results from the Norfolk Arthritis Register

J H Humphreys  1 , A Warner, J Chipping, T Marshall, M Lunt, D P M Symmons, S M M Verstappen
Affiliations

Mortality trends in patients with early rheumatoid arthritis over 20 years: results from the Norfolk Arthritis Register

J H Humphreys et al. Arthritis Care Res (Hoboken). 2014 Sep.

Erratum in

  • Arthritis Care Res (Hoboken). 2015 Jan;67(1):135

Abstract

Objective: To examine mortality rates in UK patients with early rheumatoid arthritis (RA) from 1990-2011 and compare with population trends.

Methods: The Norfolk Arthritis Register (NOAR) recruited adults with ≥2 swollen joints for ≥4 weeks: cohort 1 (1990-1994), cohort 2 (1995-1999), and cohort 3 (2000-2004). At baseline, serum rheumatoid factor and anti-citrullinated protein antibody were measured and the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria were applied. Patients were followed for 7 years, until emigration or death. The UK Office for National Statistics notified the NOAR of the date and cause of deaths, and provided mortality rates for the Norfolk population. All-cause and cardiovascular-specific standardized mortality ratios (SMRs) were calculated. Poisson regression was used to compare mortality rate ratios (MRRs) between cohorts and then, with cubic splines, to model rates by calendar year. Analyses were performed in patients 1) with early inflammatory arthritis, 2) classified as having RA, and 3) autoantibody positive.

Results: A total of 2,517 patients were included, with 1,639 women (65%) and median age 55 years, and 1,419 (56%) fulfilled the 2010 RA criteria. All-cause and cardiovascular-specific SMRs were significantly elevated in the antibody-positive groups. There was no change in mortality rates over time after accounting for changes in the population rates. In RA patients, all-cause MRRs, compared to cohort 1, were 1.13 (95% confidence interval [95% CI] 0.84-1.52) and 1.00 (95% CI 0.70-1.43) in cohorts 2 and 3, respectively.

Conclusion: Mortality rates were increased in patients with RA and SMRs were particularly elevated in those who were autoantibody positive. Compared to the general population, mortality rates have not improved over the past 20 years.

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Figures

Figure 1
Figure 1
Observed and expected mortality rates by calendar year for all-cause (A) and cardiovascular (CV)–specific (B) mortality. Observed rates were modeled using Poisson regression with natural splines and expected rates were calculated from mortality rates for Norfolk, age and sex standardized to the study population. The y-axes show rates per 1,000 person-years and 95% confidence intervals (95% CIs). NOAR = Norfolk Arthritis Register.
See this image and copyright information in PMC

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