Mortality Trends in RA: The Rheumatoid Factor | Arthritis Information

Mortality Trends in Rheumatoid Arthritis: The Role of Rheumatoid Factor

+Author Affiliations

From the Department of Internal Medicine, Caritas St. Elizabeth’s Medical Center, Boston, Massachusetts; Division of Epidemiology and Biostatistics, Department of Health Sciences Research; Division of Rheumatology, and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA

Address reprint requests to Dr. S.E. Gabriel, Mayo Foundation, 200 First St. SW, Rochester, MN 55905. E-mail: gabriel.sherine@mayo.edu

Abstract

Objective

We previously demonstrated a widening in the mortality gap between subjects with rheumatoid arthritis (RA) and the general population. We examined the contribution of rheumatoid factor (RF) positivity on overall mortality trends and cause-specific mortality.

Methods

A population-based RA incidence cohort (1955–1995, and aged ≥18 yrs) was followed longitudinally until death or January 1, 2006. The underlying cause of death as coded from national mortality statistics and grouped according to ICD-9/10 chapters was used to define cause-specific mortality. Expected cause-specific mortality rates were estimated by applying the age-, sex-, and calendar-year-specific mortality rates from the general population to the RA cohort. Poisson regression was used to model the observed overall and cause-specific mortality rates according to RF status, accounting for age, sex, disease duration, and calendar year.

Results

A cohort of 603 subjects (73% female; mean age 58 yrs) with RA was followed for a mean of 16 years, during which 398 died. Estimated survival at 30 years after RA incidence was 26.0% in RF+ RA subjects compared to 36.0% expected (p < 0.001), while in RF– RA subjects, estimated survival was 29.1% compared to 28.3% expected (p = 0.9). The difference between the observed and the expected mortality in the RF+ RA subjects increased over time, resulting in a widening of the mortality gap, while among RF– RA subjects, observed mortality was very similar to the expected mortality over the entire time period. Among RF+ RA subjects, cause-specific mortality was higher than expected for cardiovascular [relative risk (RR) 1.50; 95% confidence interval (CI) 1.22, 1.83] and respiratory diseases [RR 3.49; 95% CI 2.51, 4.72]. Among RF– RA subjects, no significant differences were found between observed and expected cause-specific mortality.

Conclusion

The widening in the mortality gap between RA subjects and the general population is confined to RF+ RA subjects and largely driven by cardiovascular and respiratory deaths.

I wonder if those stats will change for people diagnosed since 1995When was this study published and what years were these people followed? Medicines , they took, etc?http://www.jrheum.com/subscribers/08/06/1009.htmlduh..I see the years no!The ultimate reasons for clinical remission to be your goal. wow.. that's interesting....... scarey but interesting.

thanks, Lynn!!

This was interesting to me. I guess this happens when someone has symptoms of something new that are assumed to be coming from RA?:

"Improvements in life expectancy in the general population during the last few decades have been attributed mainly to reductions in mortality due to cardiovascular diseases and unintentional injury²¹. Reductions in major cardiovascular risk factors and evidence-based medical therapies for primary and secondary prevention of heart disease were the major contributors of improvements in cardiovascular mortality²². Given these trends in the general population, there are at least 2 potential explanations for lack of improvements in mortality in RF+ RA subjects. First, RA subjects may not have received the same level of primary and secondary prevention interventions as their non-arthritic peers. This is conceivable, since underdiagnosis and undertreatment of comorbidities in RA patients have been reported, especially in the setting of unrecognized coronary heart disease and heart failure in RA subjects^23-25. The second potential explanation is failure of the primary and secondary preventive interventions to provide the same level of beneficial effects in RF+ RA subjects as in the general population or the RF– RA subjects. If true, this would suggest different biological pathways for cardiovascular disease in RF+ and RF– RA subjects that would in turn require different approaches to prevention and treatment. Although earlier studies reported seropositivity as a significant predictor of mortality in RA^6-10, none addressed trends over time in comparison to the general population."

or... as I've discovered myself... we don't feel the symptoms due to medications... ?? I know I don't feel pain at my usual level... due to taking NSAIDS [QUOTE=babs10]or... as I've discovered myself... we don't feel the symptoms due to medications... ?? I know I don't feel pain at my usual level... due to taking NSAIDS[/QUOTE]

Good point, babs.
Pain has absolutely nothing to do with the inflammatory process and RF. You can have a high RF and inflammation with little or no pain. As long as your inflammatory markers are positive then your RA is active. As long as your RA is active then the chance of cardiac complications rise. If one can achieve clinical remission early in the disease process then there's less chance of cardiac complications. This is the reason it's so important to try and achieve clinical remission early in the disease.

I wish these studies had been available when I was first diagnosed, maybe I would have taken the disease more seriously and tried for clinical remission rather than just feeling somewhat better. I can't stress enough the importance of partnering with your RD to achieve clinical remission. Maybe in 10 years the gap will close due to the use of dmards and biologics early on in the disease process. Maybe more RA positive individuals will achieve clinical remission early on. Lindy

Thanks LinB ... I do completely agree w/ your post... And my mortality IS my reason for reaching toward remission..

except that warming signals for heart issues may NOT be felt due to pain meds.. that was the reason behind my pain post.

those of us w/out inflammatory markers are another story.....

Hi Babs, you're so right about the warning signals for some type of heart disease but for others there's no warning signals; they're asymptomatic until they're at crisis level. My heart complication was found on a routine post op EKG. Had a heart cath. It's still asymptomatic and until it starts causing problems medication can't be taken. My doctors watch me pretty carefully. The same with my pulmonary complication. Right now they both seem to be stable.

I would love to see a study done on sero-negative individuals. Am really curious if their life expectancy is the same as positive individuals. If you or anyone else knows of such a study, please post. Hopefully my genes will help me out here. I had both of my great grandmothers alive at 101 and 105 years of age. My GM died at 91 and my mom at 86. Genes might be my saving grace.

Babs, I'm so happy to hear that you're working towards CR and it's your goal. I don't know how old you are buy if you had JRA then you've had a long battle with the disease. Just make sure you get a cardiac workup with full testing and a yearly cardiac follow-up. Many of the cardiac diseases are silent. Usually by the time you have pain it's too late for prevention. Prevention can help alleviate further damage. Lindy

LinB2009-01-31 11:36:29Lindy, I wish I had taken my RA more seriously too. At the time, it was all about controling the pain and the RA doc I had was more interested in how many patients he could see in a day.

All of this is even more proof for putting together that team of docs you can work with and who communicate well.

[QUOTE=waddie]

All of this is even more proof for putting together that team of docs you can work with and who communicate well.

[/QUOTE]

I so agree with you!

Having a good team of docs who listen and communicate with each other, is a must when you have RA.

Sometimes I think getting a "team" together is more difficult than getting to the point of clinical remission. I really agree that achieving CR can only be done with the cooperation of everyone and doing your research. You have to have a group of doctors who listen to you, take you seriously, and are aggressive in treating your disease. LindyI wish they'd clarify the degree of RF+. I don't believe that a low positive is the same as a high positive. This means little to me until they identify RF numbers.Well, two years into this and I've had my first heart attack.
Smoking and this disease are not increasing my chances of survival.

I'd say the next might take me out or at the best I will get to three times lucky.
I've been told I still have another moderate blockage.
I am so happy you replied LinB... You.. and Lynn... and some others are my heros! Seriously.. you've worked at it.. and it is work... and found your remission.. hopefully for life!

I am 51 years old.. having had JRA at age 10... but, as I may have said in another thread, the severity of my disease lessened during the fertile years... why? I have NO clue.. did hormones put the monster to sleep??? now in menopause, it is back with a vengence!!

Once I get beyond this three week infection and get back on meds... I am setting up a full work up... all of it.. cholesterol... to stress test.......

I am young... and have some longevity (except my dear mother) in the women of my past.. I am hopeful also, that it brings me a better chance for a good long life ....

Stephen, how old are you?

I quit smoking when I was 53, and believe me, it isn't easy but it's not impossible. It's been 3 years (as of last Wednesday -- I'm counting!!!) and I thank God every day that I was able to do it, because I am a different person now, mentally and physically. I smoked a lot and was completely addicted. If I was able to do it, ANYONE can. It took several tries, and finally it worked.

If you can quit, it will improve your odds by a lot. Plus, you'll feel so much better.

I quit smoking 9 years ago. I used the gum. I used the gum for 51 weeks, then I used the patch to get off the gum. It turned ut at that poihnt it was mostly psychological because I only had t use 2 patches.

It is hard but you can do it.

And you will be really glad you did.I'm more worried about living than dying....

Trust me when I say there are a lot of people that would like the thorn removed from their backsides.

An extract from an email I received this morning about heart attack.

3. Don't assume it couldn't be a heart attack because you have a
normal cholesterol count. Research has discovered that a cholesterol
elevated reading is rarely the cause of an MI (unless it's unbelievably
high and/or accompanied by high blood pressure). MIs are usually caused
by long-term stress and inflammation in the body, which dumps all sorts
of deadly hormones into your system to sludge things up in there.

I'm a stress head, I smoke, and I have RA (inflammation).
I could have a real pity party at the moment..

there there Bodak... Don't have the pity party.. is there anyway you can learn change? Stress? there are lots of ways to deal w/ true stress... and the smoking... and continue to work toward Remission... I wish you all the best with that..

I just quit smoking in October... I feel tremendous... and couldn't be happier I finally did it.. I will never quit again!!!
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