Death attributed to antirheumatic medication in a nationwide series of 1666 patients with rheumatoid arthritis who have died

Abstract

Objective: Most drugs used in rheumatoid arthritis (RA) can have fatal side effects, but there are no good data on the frequency of such complications. Our study was designed to obtain information on deaths attributable to different antirheumatic drugs.

Methods: The role of antirheumatic medication as a cause of death was studied in 1666 subjects who died in Finland in 1989 and had been entitled under the nationwide sickness insurance scheme to receive specially reimbursed medication for RA.

Results: Forty-seven deaths were attributed to antirheumatic medication. Thirty deaths were attributed to the use of nonsteroidal antiinflammatory drugs (NSAID) (17 from peptic ulcer, 11 perforation or hemorrhage of the lower intestinal tract, one renal failure, and one bone marrow depression) and 11 deaths to the use of glucocorticoids (2 from perforations of the lower intestinal tract, 5 osteoporotic fractures, 3 septicemias after intraarticular injections and one adrenal insufficiency after abrupt discontinuation of treatment). There were 2 cases of fatal bone marrow depression attributed to methotrexate and 2 to sulfasalazine, one case of lymphoma induced by azathioprine and one hydroxychloroquine intoxication. In spite of widespread use of injectable gold in Finland, there were no deaths attributed to side effects of gold.

Conclusion: The data emphasize the frequent occurrence of fatal side effects from NSAID and from glucocorticoids and the relative safety of treatment with gold.