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Maybe RA Patients Don't Die of a Broken Heart After All

November 10 2015 10:31 PM ET via RheumReports RheumReports

Diane Lacaille presented critical data at yesterday's plenary session suggesting that the previously recognized increased risk of mortality in RA may be closing in on that seen in the general population. Her retrospective cohort study of all incident RA cases in British Columbia with matched general population controls used administrative data. 

Out of 24,919 RA cases and controls, all-cause mortality rates of 24.43 and 18.77 per 1000 patient-years in RA patients and controls were reported, with a mortality rate ratio of 1.30 (95% CI 1.23-1.38). Mortality was significantly increased in RA vs controls in the earlier but NOT in later incident cohorts for all-cause and cause-specific mortality.  So those patients who got RA after 2000 had the same mortality risk as the general population vs the increased risk in those with RA presenting before 2000. 

So perhaps when we are telling our patients that "they are going to make it" – we have to qualify this by stating that treating aggressively – i.e., treating to target – may be why. Dr. Lacaille's data are robust in spite of being administrative – but it should not make us lazy. This mortality gap closure may reflect our treatment paradigm shift, newer drugs and hopefully, some traditional cardiovascular risk factor modification. 

Perhaps we can use this information at the bedside when we try to convince our patients to take all these drugs. The data can support our treatment approach, reminding them that the risk of CV mortality is reduced now that we are more aggressive. It will be curious to see other groups confirm Dr. Lacaille's findings. 


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About the Author

Dr. Stephanie Keeling
Dr. Stephanie Keeling

Dr. Stephanie Keeling is an Associate Professor at the University of Alberta. Her research interests include lupus and connective tissue disorders.

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