Mortality in rheumatoid arthritis: Do age and gender make a difference?

doi:10.1016/S0049-0172(96)80015-1

Seminars in Arthritis and Rheumatism

Volume 25, Issue 5, April 1996, Pages 291-296

https://doi.org/10.1016/S0049-0172(96)80015-1 Get rights and content

Abstract

Rheumatoid arthritis (RA) is a significant cause of morbidity and mortality inboth sexes. The extent to which age and gender are risk factors for increased mortality in RA, however, is still not clear. A review of existing literature on the effect of gender and age on mortality was performed. Twenty-five articles were identified from the world literature over the past decade. Ten articles representative of the existing literature in this field were analyzed in detail. Articles chosen as representative were characterized by peer-reviewed publication, large sample size, and geographic diversity of patient populations. One detailed analysis of prior literature also was included. The results failed to show a clear association between gender, age, and mortality in RA. Retrospective analyses of death certificates suggest an increased mortality among elderly women with RA. Longitudinal studies, however, suggest that both increasing age and male sex portend a worse prognosis in RA. A better understanding of mortality risk factors in RA, particularly with respect to age and gender, would require large randomized prospective trials conducted over long periods.

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These characteristics are consistent with the previous findings associated with increased mortality [9–11]. A higher SMR among men than women was consistent with findings from other Asian studies [16,17] but the gender effect has been controversial so far [23]. RA patients of Korea showed the highest vulnerability for death during their 60s and 70s.
To compare all-cause and cause-specific mortality between rheumatoid arthritis (RA) patients versus the general population of Korea.
A nationally representative RA population aged ≥ 40 years was identified from Korea National Health Insurance Service (KNHIS) database. We estimated age- and sex-adjusted all-cause and cause-specific standardized mortality ratios (SMRs) with 95% confidence intervals (CIs), comparing RA patients to the general population. Subgroup analyses were done by sex, age group, calendar year, and biologics use.
We identified 79,352 RA patients with 6404 deaths during 2011–2016. The all-cause SMR [95% CI] of RA patients compared to the general population was 1.53 [1.49–1.56]. The top five causes of death were cancer (19.5%), respiratory disease (19.1%), cardiovascular disease (18.8%), systemic rheumatic diseases (9.5%, 9.1% due to RA), and infection (6.1%). Cause-specific SMRs [95% CI] were 0.95 [0.90–1.01] for cancer, 3.34 [3.15–3.52] for respiratory disease, 1.26 [1.18–1.33] for cardiovascular disease, 3.41 [3.08–3.75] for infection, and 4.88 [3.10–6.65] for non-RA systemic rheumatic disease. The SMR of RA population was slightly higher among men than women, and highest in their 60s and 70s. The yearly SMR increased from 1.10 [1.01–1.18] in 2011 to 1.85 [1.75–1.95] in 2016 due to population aging and comorbidity accumulation. Users of biologics showed a higher SMR than non-users (1.82 [1.69–1.96] vs. 1.50 [1.46–1.54]), due to higher RA activity, and more comorbidities despite a younger mean age.
RA patients in Korea experienced 1.5-fold increase in all-cause mortality compared to the general population. Except for cancer, the top five causes of death were associated with excess mortality among RA patients. RA-associated mortality was largely determined by age, RA activity, and comorbidity status.
Interstitial Lung Diseases and the Impact of Gender
2021, Clinics in Chest Medicine
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Studies investigating quality of life during the disease course showed increased rates of depression and worse quality of life in females with rheumatoid arthritis compared with males, but were inconclusive for sex-dependent differences in patients with systemic sclerosis.119,121 Finally, male sex portended poorer prognosis in both rheumatoid arthritis and systemic sclerosis.122–124 LAM has been established as an ILD occurring almost exclusively in females either sporadically or in association with tuberous sclerosis complex.125
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Predictors of mortality in patients with rheumatoid arthritis in Lithuania: Data from a cohort study over 10 years
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The extent, to which age and gender add to the risk for increased mortality in RA, is still not clear. The results of the review conducted by Anderson [22] failed to show a clear association between gender, age and mortality, except for the increased mortality among elderly women [23]. Nevertheless, according to the review by Goronzy et al. by several immune aging biomarkers, the immune system in patients with RA is prematurely aged by more than 20 years [24].
Increased mortality and shorter survival among rheumatoid arthritis (RA) patients are recognized but not fully explained. This cohort study aimed to identify predictors of mortality among RA patients at a tertiary clinical setting.
Patients with RA were recruited during 1998–2003 and followed up until April 1, 2012, or death whichever happened first. Baseline variables included sociodemographic and disease characteristics, and comorbidities. Cox regression and hazard risk (HR) were computed to estimate risks for mortality.
One hundred ninety-one patients were included into the study, 186 patients were eligible for the analysis and of these 131 patients (70.4%) completed the entire period of followed-up while 55 patients (29.6%) died. The average follow up period was equivalent to 9.24 year per person. A Cox regression model identified four major factors having an impact on survival. History of a stroke at baseline was identified as a major factor (HR = 5.33; 95% CI, 2.13–13.32). Statistically significant risk factors were also age over 50 years (HR = 4.59; 95% CI, 2.04–10.30); education less than 11 years (HR = 3.3; 95% CI, 1.72–6.33) and angina pectoris (HR = 1.98; 95% CI, 1.03–3.80).
Higher age, lower education and cardiovascular comorbidities were identified as predictors of mortality in this prospective cohort study while disease-related variables were not independent predictors of mortality.
Recurrent embolic strokes associated with vertical atlantoaxial subluxation in a patient with rheumatoid arthritis: A case report and review of literature
2013, Journal of Stroke and Cerebrovascular Diseases
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Atlantoaxial subluxation (AAS), which is because of destruction of the transverse ligament, with subsequent laxity, occurs in patients with rheumatoid arthritis (RA).1 AAS may cause severe neurological morbidity, including paresthesia, cervical myelopathy, vertebrobasilar insufficiency, and even sudden death because of brainstem and spinal cord compression.1-3 Transverse ligament destruction may cause anterior or vertical subluxation, at 5% and 1.4%, respectively.1
We report a 78-year-old woman with rheumatoid arthritis who developed recurrent embolic cerebellar strokes associated with vertical atlantoaxial subluxation (AAS). On contrast angiography, the bilateral vertebral arteries (VAs) were occluded between the C1 and C2 levels, and the distal parts of bilateral VA were supplied by the collateral circulations. Dynamic cerebral angiography and carotid duplex ultrasonography showed that blood flow was substantially decreased in the left VA and left posterior inferior cerebellar artery on cervical anteflexion. It is suggested that vertical AAS reduced the blood flow of collateral circulation in the left VA with cervical anteflexion and might be a cause of recurrent ischemic stroke.
Cardiovascular Morbidity and Mortality in Rheumatoid Arthritis
2008, American Journal of Medicine
Citation Excerpt :
Many studies, dating back more than 50 years, have reported an increased risk of mortality in patients with rheumatoid arthritis (RA).1-5
Patients with rheumatoid arthritis (RA) are at increased risk of mortality compared with the general population. Evidence suggests that this increased mortality can largely be attributed to increased cardiovascular (CV) death. In a retrospective study of an inception cohort of RA patients in Rochester, MN, we found that patients with RA were at increased risk of CV death, ischemic heart disease, and heart failure compared with age- and sex-matched community controls. In addition, when we examined coronary artery tissue from autopsied RA patients, we observed increased evidence of inflammation and an increased proportion of unstable plaques. We also investigated the contribution of traditional and RA-specific risk factors to this increased risk of CV morbidity and mortality. Although traditional CV disease risk factors were found to contribute to the increased risk of mortality in RA patients, they did not fully explain the increased CV mortality observed in RA. Instead, increased inflammation associated with RA appears to contribute substantially to the increased CV mortality. Together with other studies that have demonstrated similar associations between RA and CV mortality, these data suggest that more aggressive management of inflammation in RA may lead to significant improvements in outcomes for patients with RA.

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Mortality in rheumatoid arthritis: Do age and gender make a difference?

Abstract

Rheum Dis Clin North Am

Semin Arth Rheum

Taking mortality in rheumatoid arthritis seriously: Predictive markers, socioeconomic status and comorbidity

J Rheumatol

Sex differentials in morbidity and mortality risks examined by age and cause in the same cohort

Am J Epidemiol

Mortality predictors among 263 patients with rheumatoid arthritis

J Rheumatol

The ‘side effects’ of rheumatoid arthritis: Joint destruction, disability and early mortality

Br J Rheumatol

The tmortality of rheumatoid arthritis

Arthritis Rheum

Survival and cause of death in rheumatoid arthritis: A 25-year prospective follow-up

J Rheumatol

Ten year mortality and causes of death in patients with rheumatoid arthritis

BMJ