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Why do patients with RA die and can T2T improve mortality?

November 16 2014 6:14 PM ET via RheumReports RheumReports

Rheumatoid arthritis has been associated with increased mortality. A recent meta-analysis comprised of almost 52,000 patients showed a Standardized Mortality Ratio (SMR) of 1.47 for RA (Dadoun S, et al, Joint Bone Spine 2013). The increased mortality was most marked for seropositive RA.

At the plenary session today, mortality data from the Nurses' Health Study was presented. This study analyzed 964 incident RA cases in a population of 119,200 patients followed since 1976. Overall a 51% increased mortality risk was observed for seropositive RA patients. Respiratory deaths (due to COPD & ILD) were 3-fold higher for seropositive RA. Cardiovascular mortality was increased by 45% in both seropositive and seronegative patients. Interestingly, there was no increased cancer mortality and no increased mortality of seronegative patients.

Can the increased risk of mortality in patients with RA be tempered with current treat-to-target (T2T) strategies? A Dutch group presented a study examining the 10-year survival of patients with early RA from the BeST study.

This study used SMRs to compare the BeST population to the general Dutch population. At year 10, 429 (84%) of patients were alive. There was no difference between treatment strategies in terms of mortality.

The SMR for the overall BeST population was 1.16 (0.92-1.46). This means that the mortality in this population was not significantly different from the general population. In this study, a secondary analysis identified age, male gender, smoking and functional ability as risk factors for increased mortality. Surprisingly, the disease activity (DAS) was not a risk factor.

A critique of the BeST trial is that it used a “healthier” cohort that excluded patients with significant co-morbidities that are known to increase mortality. Therefore, the participants in the BeST trial may not reflect the general population.

Stay tuned, I’m sure there will be more on this important topic.


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About the Author

Dr. Andy Thompson
Dr. Andy Thompson

Dr. Andy Thompson is an Associate Professor at Western University and founder of Rheuminfo.com, Rheumtalks.com, and RheumReports.com.

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