We've known for a while now that people with RA die younger than the general population. Recent studies have shown that although mortality is decreasing in RA compared to age- and sex-matched population estimates, the standardized mortality ratio remains unchanged. In other words, age at death is decreasing equally in patients with RA and the general population, so there is still a gap with early mortality in RA.
In an analysis of the Nurses' Health Study presented by Sparks JA et al at ACR 2014, incident cases of RA in women were followed for 34 years (abstract #818). Nurses diagnosed with RA had twice the risk of death from any cause compared to women without RA when matching for known CVD confounders. The excess mortality was from cardiovascular and cancer deaths. Respiratory mortality was 6 times more frequent in seropositive RA patients.
Markusse IM et al reported survival data from the BeST study that evaluated various treat-to-target strategies in early RA (abstract #817). After 10 years of continued tightly controlled treatment, the survival rate for patients with early RA was comparable to the general Dutch population. This data must be interpreted with caution since it is likely biased by the healthy worker effect, which means that patients enrolled in trials do better than those who are not enrolled even if they have similar baseline characteristics.
So if a patient says my joints are killing me, they are probably right and perhaps treating to target may decrease mortality!
Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.View Full Bio