Mortality and survival in rheumatoid arthritis: a 25 year prospective study of 100 patients

Article Abstract:

Rheumatoid arthritis (RA) does not run an even course, and its effects on patients can differ greatly. Incidence of acute episodes can vary from infrequent to a sustained progression to deformity. Early death has been reported to be associated with severe RA, and this may be related either to the disease, its complications, or its treatment. Studies that have evaluated long-term morbidity (illness) and mortality vary in their conclusions, depending on whether study subjects are drawn from hospitals and clinics (where more severe disease is seen) or community-based populations (where milder cases are more available). A 25-year study has evaluated 100 patients with RA since early in the disease, according to a prospective type of experiment design, and this provides a satisfactory way of assessing the course of RA. At 25 years, 37 patients were surviving, and the excess mortality (i.e. the number of deaths above those expected) was calculated to be 40 percent. Nineteen percent of deaths were directly attributable to RA, while 14 percent were associated with it. The incidence of vascular disease was not different from the general population. Infection leading to death was found in 16 percent of patients, and may be related to the disease or to long-term steroid treatment. Malignant disease-related death was lower than in the general population. Renal disease, vasculitis, and spinal cord compression were other RA-related causes of death. The ratio of women to men among the survivors was twice that of the original group, and milder disease was associated with survival. Conversely, two early signs of more severe disease, low levels of hemoglobin and an elevated ESR (erythrocyte sedimentation rate), were associated with a serious prognosis. These were markers of inflammation, control of which is necessary to limit joint disease. Data from other studies suggest that with spontaneous remission in one third of cases and aggressive treatment with surgery and chemotherapy in remaining cases, morbidity and mortality may start to decrease; long-term studies will tell. The study concludes that RA remains a serious disease for many patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality

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Occurrence of rheumatoid arthritis is not increased in the first degree relatives of a population based inception cohort of inflammatory polyarthritis

Article Abstract:

Immediate family members of patients with rheumatoid arthritis (RA) do not seem to be at greater risk for RA than the general population. Genetic links for RA have been identified, but it is still hard to predict the occurrence of RA in relatives of RA patients. Researchers evaluated 518 immediate family members of 207 patients with RA (study group) and 414 immediate family members of 180 matched volunteers (controls) for evidence of RA. There was no significant difference between the overall prevalence of confirmed or unconfirmed RA in the study group families (2.9%) and the control group families (2.2%). Only 1.6 times more immediate family members of the study group had confirmed cases of RA as compared to the immediate family members of the control group.

Risk factors, Genetic aspects, Familial diseases

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http://www.ilar.org: a source of information for rheumatologists, allied health professionals, medical students and the general public

Article Abstract:

The International League of Associations of Rheumatology has launched its own Web site. Established in 1998, the site will contain links rheumatological associations all over the world as well as to other sites containing information about rheumatic diseases.

Information services, Rheumatic diseases

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