LONG-TERM MORTALITY OUTCOME IN PATIENTS WITH RHEUMATOID-ARTHRITIS - EARLY PRESENTERS CONTINUE TO DO WELL

Objective. Patients with rheumatoid arthritis (RA) have reduced life e xpectancy; however, there are few data on the changing pattern of caus es of death with longterm followup, or on the longterm effect of early presentation. The objectives of this study were (1) to examine the ef fect of early presentation on subsequent mortality; (2) to compare the causes of death early and late in the followup period; and (3) to com pare survival of the cohort with that of the general population (adjus ted for age and sex) over a followup period of up to 27 years. Methods . A cohort of 448 patients with RA (inpatients and outpatients), assem bled 1968-74, were followed to December 31, 1990. Death certificates w ere obtained for all who had died and coded using the International Cl assification of Diseases. Kaplan-Meier survival curves were constructe d. Results. By the end of the study, 266 patients (59%) had died. The standardized mortality ratio (SMR) was 2.7 (95% CI 2.4-3.1). Patients who presented early continued to do well. Most excess deaths were due to cardiovascular disease. SMR due to infection, renal failure, and no n-Hodgkin's lymphoma rose with disease duration. Conclusion. Patients with RA should be referred early, and those with chronic disease shoul d be closely monitored for evidence of infection and renal impairment.