People with rheumatoid arthritis (RA) appear to have a higher risk of mortality than the general population, but aggressive treatment may improve survival, according to two recent studies. These findings were presented at the 2014 American College of Rheumatology Annual Meeting, November 14–19, in Boston, Massachusetts.,
People with RA have a higher risk of dying than their counterparts in the general population. According to the Centers for Disease Control and Prevention, RA patients are more than twice as likely to die than people of the same age in the general population.
In a study that included women from the Nurses’ Health Study (NHS), researchers compared mortality among women with RA with women without RA. They followed just over 120,000 women from 1976 through 2010 (34 years); women were followed through the end of the study or until death. A total of 906 participants were diagnosed with RA over the course of the study.
Cause of death was validated using the National Death Index, a death certificate, and medical record review. Causes of death were compared between women with RA and the general population in the following categories: all-cause mortality, cardiovascular disease, cancer, and respiratory illness.
Researchers with the NHS identified just over 25,000 deaths during the 34 years of study. Of these deaths, 261 were women with RA.
Women with RA had a twofold increased risk of death compared with those without RA (all-cause mortality), even after researchers took into account other factors affecting mortality (such as age and other health factors). Furthermore, the length of time women had lived with RA appeared to affect mortality: each five years of living with RA increased mortality by 32%. Respiratory mortality was the leading factor in RA death compared with women without RA: women with RA were six times more likely to die from respiratory complications. Women with RA were also significantly more likely to die from cardiovascular disease and cancer.
While the NHS findings confirmed higher mortality among people with RA, researchers with a second study, conducted in the Netherlands, questioned whether improvements in treatment of the disease can also helped lower mortality.
To investigate whether treatment that decreases disease activity in RA might also decrease risk of death, researchers assessed survival among patients who received 10 years of aggressive treatment for RA. They compared these survival rates with the general population and also sought to determine risk factors for death among people undergoing treatment for RA.
The study included 508 patients with RA that had recently developed. Patients were assigned to one of four treatment groups: sequential monotherapy (use of one agent at a time), step-up therapy (sequential addition of new disease-modifying antirheumatic drugs to existing treatment when response isn’t optimal), initial combination with prednisone, or initial combination with Remicade® (infliximab). Researchers followed patients for 10 years, during which they were treated with a treat-to-target approach, meaning they were treated aggressively by changing therapies periodically until disease was controlled. They compared survival rates between the four treatment strategies and with the general population.
Of the 508 participants, 72 died during the 10 years of study. The four different treatment strategies did not appear to affect survival, as there were no differences in survival rates between groups. Study participants had a similar rate of survival to the general population.
Factors that appeared to increase risk of mortality among patients treated for RA included: age at the beginning of the study (baseline), male gender, smoking at baseline, and results of a health-assessment questionnaire at baseline. The type of treatment received did not appear to affect mortality.
Patients in this study who were undergoing treatment for RA had survival rates that were comparable to the general population. These findings suggest that aggressive disease control (treat to target) in RA patients can decrease mortality. They also demonstrate that the therapies used in these aggressive treatments did not increase risk of death.
 Sparks JA, Chang S-C, Liao KP, et al. Incident Rheumatoid Arthritis and Risk of Mortality Among Women Followed Prospectively from 1976 to 2010 in the Nurses’ Health Study. Program and Abstracts of the American College of Rheumatology Annual Meeting 2014; November 14–19; Boston, Massachusetts. Abstract 818.
 Markusse M, Dirven L, van Groenendael JH, et al. Mortality in a Large Cohort of Patients with Early Rheumatoid Arthritis that Were Treated-to-Target for 10 Years. Program and Abstracts of the American College of Rheumatology Annual Meeting 2014; November 14–19; Boston, Massachusetts. Abstract 817.
 Rheumatoid Arthritis. The Centers for Disease Control and Prevention website. Available at . Accessed November 20, 2014.