Mortality gap widening between rheumatoid arthritis patients, general population

Last Updated: 2007-10-29 14:11:13 -0400 (Reuters Health)

NEW YORK (Reuters Health) – The decline in mortality rates seen in the US population over the past 4 decades has not occurred among patients with rheumatoid arthritis, despite innovations in rheumatoid arthritis treatment, according to a report in the November issue of Arthritis & Rheumatism.

Rheumatoid arthritis (RA) is known to be associated with excess mortality, the authors explain, but whether survival in RA patients has improved over time remains unclear.

Dr. Sherine E. Gabriel and colleagues from the Mayo Clinic, Rochester, Minnesota evaluated trends in mortality rates in a population-based group of patients in whom RA was first diagnosed between 1955 and 2000 and who were followed until 2007, as compared with expected mortality rates in the general population of individuals of the same age and sex.

Overall mortality among RA patients was 35% higher than that expected in the general population, the authors report, and excess mortality was more evident among female RA patients (49% excess mortality) than among male RA patients (12%).

Throughout the five time periods examined, the mortality rate remained relatively constant for both female RA patients (2.4 per 100 person-years) and male patients (2.5 per 100 person-years).

In contrast, the mortality rate in the general population declined from 1.0 per 100 person-years in women and 1.2 per 100 person-years in men in 1965, to 0.2 per 100 person-years in women and 0.3 per 100 person-years in men in 2000.

"Our findings indicate that RA patients have not experienced the same improvements in survival as the general population, and therefore the mortality gap between RA patients and individuals without RA has widened," the authors maintain.

"Although the reasons for the widening mortality gap are unclear, cardiovascular deaths constitute at least half of the deaths in patients with RA, and it is possible that the cardiovascular interventions that improved life expectancy in the general population may not have had the same beneficial effects in patients with RA," the researchers speculate.

"There is an urgent need to fully understand the determinants and implications of this phenomenon so that appropriate intervention strategies can be undertaken to reduce the widening mortality gap that increasingly separates RA patients from the rest of the general population," Dr. Gabriel and colleagues conclude.

Arthritis Rheum 2007;56:3583-3587.