Increased mortality in adults with a history of juvenile rheumatoid arthritis - A population-based study

Objective. To assess mortality in a population-based cohort of adults with a history of juvenile rheumatoid arthritis (JRA). Methods. The Rochester Epidemiology Project database was used to identify a ll cases of JRA diagnosed among Rochester, Minnesota residents under the ag e of 16 between January 1, 1960 and December 31, 1993. Fifty-seven patients in this cohort are now adults (ages 18-53 years, mean age 34.3 years), and this subgroup was contacted for a long-term followup study. The average le ngth of followup from the time of diagnosis was 25.6 years. Results. Four deaths occurred in this cohort of 57 adults with a history of JRA. All 4 deceased patients had other autoimmune illnesses and died of co mplications of these diseases. The observed frequency of 4 deaths was signi ficantly greater (P < 0.0026 by one-sample log-rank test) than the 1 death that would be expected among Minnesota whites of similar age and sex, and c orresponds to a mortality rate of 0.27 deaths per 100 years of patient foll owup compared with an expected mortality rate of 0.068 deaths per 100 years of followup in the general population. Conclusion. The results indicate a significant, unexpected increase in mort ality in this population-based cohort of adults with a history of JRA in co mparison with the rate in the general population. The deaths in this group were all associated with other autoimmune disorders, suggesting that specia l emphasis should be given to the diagnosis and treatment of other autoimmu ne diseases, including immunodeficiencies, in JRA patients. The frequency o f deaths in this cohort suggests that JRA patients are at substantial risk for mortality, and highlights the need for longitudinal followup and care i nto adulthood.