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. 2002 Oct;61(10):889–894. doi: 10.1136/ard.61.10.889

Mortality in patients with rheumatoid arthritis treated actively from the time of diagnosis

R Peltomaa 1, L Paimela 1, H Kautiainen 1, M Leirisalo-Repo 1
PMCID: PMC1753911  PMID: 12228159

Abstract

Objectives: To evaluate the mortality rates among patients with early rheumatoid arthritis (RA) treated actively according to the "sawtooth" strategy.

Methods: The study included 150 early, disease modifying antirheumatic drug (DMARD) naive patients with RA from two patient cohorts. The first cohort was assembled between 1986 and 1989 (87 patients, aged 19–65 years at onset) and the second between 1991 and 1993 (63 patients, aged 27–83 years at onset). The mean duration of symptoms at the time of diagnosis was 7.1 months (range 2–24). The clinical data and the use of DMARDs were systematically recorded. The causes of death were obtained from death certificates and medical records, if available. The data were collected up to 1 November 2000.

Results: During a follow up time of 7–14 years, 24 patients died. The standardised mortality ratio was not increased (0.93 in the first cohort and 1.62 in the second cohort). Age adjusted mortality rates did not differ statistically significantly between the two patient cohorts. The causes of death included malignancy (8 patients); cardiovascular diseases (10); respiratory disease (4), including two patients with pneumonia; sepsis (one); and RA (one). High inflammatory activity, disease activity, and poor functional ability at study entry, and the presence of extra-articular features during the follow up were more common among the patients who had died.

Conclusions: No statistically significant increase in mortality rates was seen in these actively treated early RA cohorts during the follow up. High disease activity at the onset and the development of extra-articular features seem to be associated with mortality.

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Figure 1 .

Figure 1

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Mean cumulative number of DMARDs used during the first three years in patients who are still alive and those who died during the follow up. The differences between the two groups are not statistically significant.

Figure 2 .

Figure 2

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Antirheumatic treatment at different times in (A) patients still alive at the end of follow up and (B) patients who died during the follow up.

Figure 3 .

Figure 3

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Cumulative survival curve of the patients of the two different cohorts. The SMR (95% CI) of the first cohort was 0.93 (0.37 to 1.92) and of the second cohort 1.62 (0.95 to 2.60).

Figure 4 .

Figure 4

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Follow up time and age at the time of diagnosis of each patient in the first (A) and the second cohort (B). Solid symbols represent those who died.

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