Patients with rheumatoid arthritis (RA) have a substantially reduced l
ife expectancy. The standardized mortality ratio in different studies
has ranged from 1.13 to 2.98. This mainly applies to rheumatoid factor
(RF)-positive cases, although there is a subgroup of RE-negative case
s with an adverse long-term prognosis. Clinically based studies probab
ly overestimate the true shortening of life span and population-based
studies may underestimate it. Excess mortality from infection and from
renal disease likely reflects the presence of severe disease, whereas
most of the added mortality from gastrointestinal causes is treatment
related. The reasons for the surplus of mortality from cardiovascular
causes are not fully known. RF may have a direct role, and preillness
factors such as smoking may predipose patients to RA and also render
them susceptible to cardiovascular diseases, The excess mortality asso
ciated with RA is appreciably higher than is apparent from the cases i
n which RA is regarded as an underlying cause of death. The effect of
treatment on mortality remains largely unknown.