No increased mortality in patients with rheumatoid arthritis: up to 10 years of follow up from disease onset

Objective-To investigate mortality, functional capacity; and prognostic fac tors for mortality in an inception cohort of patients with recently diagnos ed RA followed up for up to 10 years. Methods-The observed mortality of this inception cohort with recently diagn osed RA, was analysed in relation to the expected mortality, calculated wit h the aid of life tables of the general population of the Netherlands (matc hed for age and sex). Functional capacity was measured by the Health Assess ment Questionnaire. Prognostic factors for mortality were analysed multivar iately by the Cox proportional hazards model. Results-Between January 1985 and April 1997, 622 patients entered the study , and were included in the analysis of mortality. The death rate in the fir st 10 years of the disease was not significantly different from that of the general population. Fifty five patients from the study group died (16% up to 10 years of follow up). The most commonly reported causes of death were of cardiovascular and respiratory origin. The other causes of death could b e classified into cancer, sepsis, amyloidosis, leukaemia, renal insufficien cy of unknown cause, perforation of the oesophagus, probably related to the treatment with non-steroidal anti-inflammatory drugs, and pancytopenia dur ing aurothioglucose treatment. Functional capacity improved significantly d uring the first six years compared with the value at start. Statistically s ignificant predictors for death were age at the start and male sex. Conclusions-In contrast with earlier studies performed, no excess mortality in the first 10 years of an inception cohort of patients with RA was seen. In addition, the functional capacity was relatively constant during the fi rst six years after an initial improvement from baseline. Age at start and male sex were the only statistically significant predictors for death.