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Increased mortality rate in people with rheumatoid arthritis

Mar 7, 2018


Patients with rheumatoid arthritis have increased mortality compared to the general population across most causes of death. And while causes were similar in both groups, patients with rheumatoid arthritis died at younger ages, reports a new Arthritis Care & Research-published study.

Rheumatoid arthritis is a chronic inflammatory arthritis and affects 1 per cent of adults and 2 to 3 per cent of older adults. Optimal care for rheumatoid arthritis hinges on early access to rheumatologists. The condition is characterized by widespread joint inflammation. This constant, high-grade inflammation is also strongly linked to the development of comorbid (in tandem) conditions, such as cardiovascular disease.

The researchers report a higher mortality rate for patients with rheumatoid arthritis, compared to age-and-sex matched comparators in the general population. At the time of diagnosis, they report patients with rheumatoid arthritis had a significantly higher prevalence of comorbid conditions such as hypertension, COPD (chronic obstructive pulmonary disease)/asthma, and coronary artery disease. Also in comparison, patients with rheumatoid arthritis at 45 years or younger were at three-fold, and five-fold greater risk of death due to comorbid cardiovascular, and respiratory conditions and infections (eg. pneumonia), respectively.

“Premature mortality in rheumatoid arthritis patients was elevated across all ages which emphasizes that we need strategies to improve survival for all patients. The potential years of life lost (before the age of 75) among patients with rheumatoid arthritis, was roughly double that of the general population. Additionally, patients with rheumatoid arthritis have a disproportionate burden of comorbid illness and disease even at rheumatoid arthritis onset. It is our hope that these findings will help underscore the importance of increased preventive efforts and management of comorbid conditions at earlier stages in the disease course,” says Dr. Jessica Widdifield, lead researcher and scientist at Sunnybrook Research Institute in the Holland Musculoskeletal Research Program.

“Improving timely access to rheumatologists for diagnosis and treatment is also very important,” adds Dr. Widdifield, who is also an assistant professor at the Institute of Health Policy, Management and Evaluation, University of Toronto, and an adjunct scientist at the Institute for Clinical Evaluative Sciences. “Unfortunately, this is challenging as there are too few rheumatologists to meet the needs of all rheumatoid arthritis patients.”

The study included 87,114 patients newly diagnosed with rheumatoid arthritis in Ontario (median age 57 years; 70 per cent female) between the period of 2000 and 2013. The researchers compared the mortality rates of this cohort, with a general population comparator cohort of 348,456 Canadians, directly matched by sex, age, and region of residence, in the same period, who were not diagnosed with the disease.

This research was generously supported by The Catherine and Fredrik Eaton Charitable Foundation, the Canadian Institutes of Health Research, and through the Arthritis Society Post Doctoral Fellowship (2014 – 2017).

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