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. 2005 May 5;64(10):1451–1455. doi: 10.1136/ard.2004.033761

Mortality of rheumatoid arthritis in Japan: a longitudinal cohort study

M Hakoda 1, H Oiwa 1, F Kasagi 1, N Masunari 1, M Yamada 1, G Suzuki 1, S Fujiwara 1
PMCID: PMC1755235  PMID: 15878908

Abstract

Objective: To determine the mortality risk of Japanese patients with rheumatoid arthritis, taking into account lifestyle and physical factors, including comorbidity.

Methods: 91 individuals with rheumatoid arthritis were identified during screening a cohort of 16 119 Japanese atomic bomb survivors in the period 1958 to 1966. These individuals and the remainder of the cohort were followed for mortality until 1999. Mortality risk of the rheumatoid patients was estimated by the Cox proportional hazards model. In addition to age and sex, lifestyle and physical factors such as smoking status, alcohol consumption, blood pressure, and comorbidity were included as adjustment factors for the analysis of total mortality and for analysis of mortality from each cause of death.

Results: 83 of the rheumatoid patients (91.2%) and 8527 of the non-rheumatoid controls (52.9%) died during mean follow up periods of 17.8 and 28.0 years, respectively. The age and sex adjusted hazard ratio for mortality in the rheumatoid patients was 1.60 (95% confidence interval, 1.29 to 1.99), p<0.001. Multiple adjustments, including for lifestyle and physical factors, resulted in a similar mortality hazard ratio of 1.57 (1.25 to 1.94), p<0.001. Although mortality risk tended to be higher in male than in female rheumatoid patients, the difference was not significant. Pneumonia, tuberculosis, and liver disease were significantly increased as causes of death in rheumatoid patients.

Conclusions: Rheumatoid arthritis is an independent risk factor for mortality. Infectious events are associated with increased mortality in rheumatoid arthritis.

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Selected References

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  1. Allebeck P., Ahlbom A., Allander E. Increased mortality among persons with rheumatoid arthritis, but where RA does not appear on death certificate. Eleven-year follow-up of an epidemiological study. Scand J Rheumatol. 1981;10(4):301–306. doi: 10.3109/03009748109095320. [DOI] [PubMed] [Google Scholar]
  2. Allebeck P. Increased mortality in rheumatoid arthritis. Scand J Rheumatol. 1982;11(2):81–86. doi: 10.3109/03009748209098167. [DOI] [PubMed] [Google Scholar]
  3. COBB S., ANDERSON F., BAUER W. Length of life and cause of death in rheumatoid arthritis. N Engl J Med. 1953 Oct 1;249(14):553–556. doi: 10.1056/NEJM195310012491402. [DOI] [PubMed] [Google Scholar]
  4. DUTHIE J. J., BROWN P. E., TRUELOVE L. H., BARAGAR F. D., LAWRIE A. J. COURSE AND PROGNOSIS IN RHEUMATOID ARTHRITIS. A FURTHER REPORT. Ann Rheum Dis. 1964 May;23:193–204. doi: 10.1136/ard.23.3.193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Gabriel S. E., Crowson C. S., O'Fallon W. M. Mortality in rheumatoid arthritis: have we made an impact in 4 decades? J Rheumatol. 1999 Dec;26(12):2529–2533. [PubMed] [Google Scholar]
  6. Gabriel Sherine E., Crowson Cynthia S., Kremers Hilal Maradit, Doran Michele F., Turesson Carl, O'Fallon W. Michael, Matteson Eric L. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis Rheum. 2003 Jan;48(1):54–58. doi: 10.1002/art.10705. [DOI] [PubMed] [Google Scholar]
  7. Goodson Nicola J., Wiles Nicola J., Lunt Mark, Barrett Elizabeth M., Silman Alan J., Symmons Deborah P. M. Mortality in early inflammatory polyarthritis: cardiovascular mortality is increased in seropositive patients. Arthritis Rheum. 2002 Aug;46(8):2010–2019. doi: 10.1002/art.10419. [DOI] [PubMed] [Google Scholar]
  8. Isomäki H. A., Mutru O., Koota K. Death rate and causes of death in patients with rheumatoid arthritis. Scand J Rheumatol. 1975;4(4):205–208. doi: 10.3109/03009747509165257. [DOI] [PubMed] [Google Scholar]
  9. Jacobsson L. T., Knowler W. C., Pillemer S., Hanson R. L., Pettitt D. J., Nelson R. G., del Puente A., McCance D. R., Charles M. A., Bennett P. H. Rheumatoid arthritis and mortality. A longitudinal study in Pima Indians. Arthritis Rheum. 1993 Aug;36(8):1045–1053. doi: 10.1002/art.1780360804. [DOI] [PubMed] [Google Scholar]
  10. KELLGREN J. H. Diagnostic criteria for population studies. Bull Rheum Dis. 1962 Nov;13:291–292. [PubMed] [Google Scholar]
  11. Kato H., Duff I. F., Russell W. J., Uda Y., Hamilton H. B., Kawamoto S., Johnson K. G. Rheumatoid arthritis and gout in Hiroshima and Nagasaki, Japan. A prevalence and incidence study. J Chronic Dis. 1971 Feb;23(9):659–679. doi: 10.1016/0021-9681(71)90161-5. [DOI] [PubMed] [Google Scholar]
  12. Kroot E. J., van Leeuwen M. A., van Rijswijk M. H., Prevoo M. L., Van 't Hof M. A., van De Putte L. B., van Riel P. L. No increased mortality in patients with rheumatoid arthritis: up to 10 years of follow up from disease onset. Ann Rheum Dis. 2000 Dec;59(12):954–958. doi: 10.1136/ard.59.12.954. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kvalvik A. G., Jones M. A., Symmons D. P. Mortality in a cohort of Norwegian patients with rheumatoid arthritis followed from 1977 to 1992. Scand J Rheumatol. 2000;29(1):29–37. doi: 10.1080/030097400750001770. [DOI] [PubMed] [Google Scholar]
  14. Lewis P., Hazleman B. L., Hanka R., Roberts S. Cause of death in patients with rheumatoid arthritis with particular reference to azathioprine. Ann Rheum Dis. 1980 Oct;39(5):457–461. doi: 10.1136/ard.39.5.457. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lindqvist E., Eberhardt K. Mortality in rheumatoid arthritis patients with disease onset in the 1980s. Ann Rheum Dis. 1999 Jan;58(1):11–14. doi: 10.1136/ard.58.1.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Mikuls T. R., Saag K. G., Criswell L. A., Merlino L. A., Kaslow R. A., Shelton B. J., Cerhan J. R. Mortality risk associated with rheumatoid arthritis in a prospective cohort of older women: results from the Iowa Women's Health Study. Ann Rheum Dis. 2002 Nov;61(11):994–999. doi: 10.1136/ard.61.11.994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Minaur Nicola J., Jacoby Richard K., Cosh John A., Taylor Gordon, Rasker Johannes J. Outcome after 40 years with rheumatoid arthritis: a prospective study of function, disease activity, and mortality. J Rheumatol Suppl. 2004 Mar;69:3–8. [PubMed] [Google Scholar]
  18. Mitchell D. M., Spitz P. W., Young D. Y., Bloch D. A., McShane D. J., Fries J. F. Survival, prognosis, and causes of death in rheumatoid arthritis. Arthritis Rheum. 1986 Jun;29(6):706–714. doi: 10.1002/art.1780290602. [DOI] [PubMed] [Google Scholar]
  19. Monson R. R., Hall A. P. Mortality among arthritics. J Chronic Dis. 1976 Jul;29(7):459–467. doi: 10.1016/0021-9681(76)90086-2. [DOI] [PubMed] [Google Scholar]
  20. Mutru O., Laakso M., Isomäki H., Koota K. Ten year mortality and causes of death in patients with rheumatoid arthritis. Br Med J (Clin Res Ed) 1985 Jun 15;290(6484):1797–1799. doi: 10.1136/bmj.290.6484.1797. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Navarro-Cano Gregorio, Del Rincón Inmaculada, Pogosian Samvel, Roldán José F., Escalante Agustín. Association of mortality with disease severity in rheumatoid arthritis, independent of comorbidity. Arthritis Rheum. 2003 Sep;48(9):2425–2433. doi: 10.1002/art.11127. [DOI] [PubMed] [Google Scholar]
  22. Peltomaa R., Paimela L., Kautiainen H., Leirisalo-Repo M. Mortality in patients with rheumatoid arthritis treated actively from the time of diagnosis. Ann Rheum Dis. 2002 Oct;61(10):889–894. doi: 10.1136/ard.61.10.889. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Pincus T., Callahan L. F., Sale W. G., Brooks A. L., Payne L. E., Vaughn W. K. Severe functional declines, work disability, and increased mortality in seventy-five rheumatoid arthritis patients studied over nine years. Arthritis Rheum. 1984 Aug;27(8):864–872. doi: 10.1002/art.1780270805. [DOI] [PubMed] [Google Scholar]
  24. Prior P., Symmons D. P., Scott D. L., Brown R., Hawkins C. F. Cause of death in rheumatoid arthritis. Br J Rheumatol. 1984 May;23(2):92–99. doi: 10.1093/rheumatology/23.2.92. [DOI] [PubMed] [Google Scholar]
  25. Reilly P. A., Cosh J. A., Maddison P. J., Rasker J. J., Silman A. J. Mortality and survival in rheumatoid arthritis: a 25 year prospective study of 100 patients. Ann Rheum Dis. 1990 Jun;49(6):363–369. doi: 10.1136/ard.49.6.363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Sokka T., Möttönen T., Hannonen P. Mortality in early "sawtooth" treated rheumatoid arthritis patients during the first 8-14 years. Scand J Rheumatol. 1999;28(5):282–287. doi: 10.1080/03009749950155463. [DOI] [PubMed] [Google Scholar]
  27. Symmons D. P., Jones M. A., Scott D. L., Prior P. Longterm mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well. J Rheumatol. 1998 Jun;25(6):1072–1077. [PubMed] [Google Scholar]
  28. Thomas Elaine, Symmons Deborah P. M., Brewster David H., Black Roger J., Macfarlane Gary J. National study of cause-specific mortality in rheumatoid arthritis, juvenile chronic arthritis, and other rheumatic conditions: a 20 year followup study. J Rheumatol. 2003 May;30(5):958–965. [PubMed] [Google Scholar]
  29. Uddin J., Kraus A. S., Kelly H. G. Survivorship and death in rheumatoid arthritis. Arthritis Rheum. 1970 Mar-Apr;13(2):125–130. doi: 10.1002/art.1780130204. [DOI] [PubMed] [Google Scholar]
  30. Wallberg-Jonsson S., Ohman M. L., Dahlqvist S. R. Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden. J Rheumatol. 1997 Mar;24(3):445–451. [PubMed] [Google Scholar]
  31. Watson Douglas J., Rhodes Thomas, Guess Harry A. All-cause mortality and vascular events among patients with rheumatoid arthritis, osteoarthritis, or no arthritis in the UK General Practice Research Database. J Rheumatol. 2003 Jun;30(6):1196–1202. [PubMed] [Google Scholar]
  32. Wolfe F., Mitchell D. M., Sibley J. T., Fries J. F., Bloch D. A., Williams C. A., Spitz P. W., Haga M., Kleinheksel S. M., Cathey M. A. The mortality of rheumatoid arthritis. Arthritis Rheum. 1994 Apr;37(4):481–494. doi: 10.1002/art.1780370408. [DOI] [PubMed] [Google Scholar]
  33. Wood J. W., Kato H., Johnson K. G., Uda Y., Russell W. J., Duff I. F. Rheumatoid arthritis in Hiroshima and Nagasaki, Japan. Prevalence, incidence, and clinical characteristics. Arthritis Rheum. 1967 Feb;10(1):21–31. doi: 10.1002/art.1780100104. [DOI] [PubMed] [Google Scholar]

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