Excess mortality persists in patients with rheumatoid arthritis

Abstract

Objectives To investigate the causes and risk of death in a large cohort of Korean patients with rheumatoid arthritis (RA). Methods Patients in the Hanyang BAE (Bae registry of Autoimmune diseases for Epidemiology) RA cohort who fulfilled the American College of Rheumatology criteria were analyzed. A total of 2355 patients were enrolled from October 2001 to December 2015. Mortality data were derived by linking with data from the Korean National Statistical Office. Standardized mortality ratio was estimated by dividing observed deaths by expected number of deaths in the general population. Results Over the observation period, 225 deaths were reported. Total age‐ and sex‐adjusted standardized mortality ratio was 1.65 (95% confidence interval 1.44‐1.87). The most common cause of death was malignancy (40 cases; 17.8%), followed by respiratory disease (38 cases; 16.9%) and cardiovascular disease (32 cases; 14.2%). Mortality rate and causes of death differed according to year and age of RA onset. Compared with survivors, individuals who died were more likely to be male, smokers, diagnosed with RA at an older age, and to have long disease duration, higher erythrocyte sedimentation rate and C‐reactive protein, higher rheumatoid factor positivity rate, more severe radiographic damage, and more comorbidities. Conclusion The mortality rate of patients with RA remains higher than that of the general population. Therefore, to improve the survival of patients with RA, attention should be paid to the management of comorbidities as well as to the RA itself.

Mortality in Korean Patients With Rheumatoid Arthritis

“…Three studies have reported the mortality rate in Korean patients with RA [9][10][11] (Table 1). The study performed by Lee et al [11] is an extension of the study performed by Kim et al [9] conducted by the same institution. These In addition, many foreign studies have previously confirmed that the mortality rate of individuals with RA is higher than that of the general population.…”

Comparative safety of Janus kinase inhibitors and tumor necrosis factor inhibitors in patients undergoing treatment for rheumatoid arthritis

“…Our study observed comparable safety incidence rates of joint replacement between the JAKi and TNFi groups. The all‐cause mortality rate of patients with RA has decreased over the past decades; however, it remains higher than that of the general population 25,26 . A few studies have revealed increased mortality in patients treated with cDMARDs but not those treated with bDMARDs.…”

Metabolic Abnormalities, Cardiovascular Disease, and Metabolic Syndrome in Adult Rheumatoid Arthritis Patients: Current Perspectives and Clinical Implications

“…A report carried out in 1953 showed excess mortality of 29% in patients with RA. 47 In 2021, these data were still worrying and showed a higher mortality rate in RA patients than in the general population, 48 and this mortality increase is due to CVR factors. 49 The pathophysiological pathways in RA cause changes in the patient's metabolism, and CVR increases when adding an unhealthy lifestyle.…”

“…A report carried out in 1953 showed excess mortality of 29% in patients with RA. 47 In 2021, these data were still worrying and showed a higher mortality rate in RA patients than in the general population, 48 and this mortality increase is due to CVR factors. 49 …”