THE MORTALITY OF RHEUMATOID-ARTHRITIS

Objective. To determine the risk and causes of death and to quantify m ortality predictors in patients with rheumatoid arthritis (RA). Method s. RA patients (n = 3,501) from 4 centers (Saskatoon n = 905, Wichita n = 1,405, Stanford n = 886, and Santa Clara n = 305) were followed fo r up to 35 years; 922 patients died. Results. The overall standardized mortality ratio (SMR) was 2.26 (Saskatoon 2.24, Wichita 1.98, Stanfor d 3.08, Santa Clara 2.18) and increased with time. Mortality was strik ingly increased for specific causes: infection, lymphoproliferative ma lignancy, gastroenterologic, and RA. In addition, as an effect of the SMR of 2.26, the expected number of deaths was increased nonspecifical ly across all causes (except cancer), with a large excess of deaths at tributable to cardiovascular and cerebrovascular diseases. Independent predictors of mortality included age, education, male sex, function, rheumatoid factor, nodules, erythrocyte sedimentation rate, joint coun t, and prednisone use. Conclusion. Mortality rates are increased at le ast 2-fold in RA, and are linked to clinical severity.