RESEARCH - Prediction of mortality in RA based on disease activity markers

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J Rheumatol. 2005 Mar;32(3):430-4.

Prediction of mortality in rheumatoid arthritis based on disease activity

markers.

Book C, Saxne T, sson LT.

Department of Rheumatology, Malmo University Hospital, Malmo; and Department

of Rheumatology, University of Lund, Lund, Sweden.

OBJECTIVE: The risks and predictors for mortality in patients with

rheumatoid arthritis (RA) were examined in a cohort of 152 consecutive

outpatients (119 women, 33 men) seen in a 2 month period. METHODS: We

evaluated 4 measures of disease activity: erythrocyte sedimentation rate

(ESR), physician and patient global assessment of disease activity, and the

Ritchie Articular Index (RAI) as mortality predictors, adjusting for disease

severity, treatment, and cardiovascular disease (CVD) comorbidity. RESULTS:

During followup from 1978 through 1998, 111 patients (86 women, 25 men)

died, and only one was lost to followup. The standardized mortality ratio

for women was 161 (95% confidence interval 129-199), for men 152 (95% CI

99-223), and for both sexes combined 156 (95% CI 128-188). In a proportional

hazards model adjusted for age and sex, at the beginning of the period and

for the whole group, significant predictors of mortality were Steinbrocker

functional class, Larsen index, CVD comorbidity, use of corticosteroids

ever, ESR, and the physician and patient global assessment of disease

activity; but the rheumatoid factor (RF), RAI, and use of disease modifying

antirheumatic drugs were not significant predictors. When evaluating the 4

assessments of disease activity adjusting for confounders, only physician

global assessment hazard ratio (HR) = 1.32 per 1 SD (95% CI 1.00-1.74) and

ESR HR = 1.47 per 1 SD (95% CI 1.11-1.93) were significant predictors.

CONCLUSION: This longterm followup study of a single clinical patient cohort

showed a significant increase in mortality among patients with RA compared

to the general population in Malmo. In addition to disease damage and CVD

comorbidity, measures of disease activity independently predicted mortality,

which supports the hypothesis that improving these variables may also

improve longterm outcome.

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