Rheumatoid arthritis (RA) is the most common inflammatory form of arthritis and affects approximately 2 million Americans. RA is a chronic, systemic autoimmune disease that preferentially attacks the joints but also attacks other organ systems such as the lungs, eyes, skin, and cardiovascular system.
The notion that its just arthritis does not apply to RA. Many recent epidemiologic studies have demonstrated that mortality rate in RA patients is higher than in people without rheumatoid arthritis.
What is more disturbing is that this increase in mortality seems to be getting worse according to a study reported in the November 2007 issue of Arthritis and Rheumatism.
"We found no evidence indicating that RA subjects experienced improvements in survival over the last 4 5 decades," senior author Dr. Sherine E. Gabriel from the Mayo Clinic in Rochester, Minnesota, said in a news release. "In fact, RA subjects did not even experience the same improvements in survival as their peers without arthritis, resulting in a worsening of the relative mortality in more recent years, and a widening of the mortality gap between RA subjects and the general population throughout time."
During the past few decades of increased survival in the population at large, patients with RA have also benefited from earlier diagnosis, newer drug protocols, and more aggressive treatment programs. However, whether these improvements in management are associated with improved survival has not been well defined.
Using the medical record database of all residents of Olmsted County, Minnesota (where the Mayo Clinic is located), the investigators identified 822 subjects with RA by American College of Rheumatology criteria, aged 18 years or older. This included all residents of Rochester, Minnesota, first diagnosed with RA between January 1, 1955, and January 1, 1995, as well as all residents of Olmsted County diagnosed with RA between January 1, 1995, and January 1, 2000.
The mean age at RA onset was 57.6 years; 71.5% of the patients were women. Follow-up continued until death or January 1, 2007. During follow-up of a median duration 11.7 years, 445 patients with RA died.
Using statistical models adjusting for age and gender, the investigators compared the survival rates of patients diagnosed with RA from 1955 to 1964, 1965 to 1974, 1975 to 1984, 1985 to 1994, and 1995 to 2000. During these 5 time periods, survival rates for RA patients did not change significantly, indicating no significant improvement in lifespan.
Although the expected mortality rate in the general population dropped dramatically for both men and women between 1965 and 2005, the mortality rate for female and male RA patients was constant at 2.4 and 2.5 per 100 person-years, respectively, during the same time period. For women in the Minnesota general population, mortality decreased from 1.0 per 100 person-years in 1965 to 0.2 per 100 person-years in 2000, whereas for men, mortality decreased from 1.2 per 100 person-years in 1965 to 0.3 per 100 person-years in 2000.
"Although the reasons for the widening mortality gap are unclear, cardiovascular deaths constitute at least half of the deaths in subjects with RA, and it is possible that the cardiovascular interventions that improved life expectancy in the general population may not have had the same beneficial effects in persons with RA," Dr. Gabriel said.
The authors do point out some potential flaws in their analysis. One study limitation was the fact that the study was conducted in 1 geographic area and the majority of subjects were Caucasian. Another shortcoming is that the study could not count individuals with RA who did not present for medical care. Finally, it is not possible to extrapolate the findings to patients diagnosed with RA after 2000, who may have been treated more aggressively with 生物疗法。
作者建议的紧急研究，澄清背后的死亡率差异的原因和解决方案将导致改善风湿关节炎患者的存活率。 （关节炎大黄。2007; 56:35833587）。
作者指出：目前，有大量的研究正在进行，以开发更有效，更有选择性和安全机关的治疗方法。无论这些疗法将会对死亡率产生重大影响仍然不确定。有证据表明，肿瘤坏死因子有趣的抑制剂有可能会减少在RA动脉粥样硬化发病率。当然，也有证据表明，这些药物可以减少在RA患者淋巴瘤的发生率。这是抵消的，在与肿瘤坏死因子抑制剂治疗的患者发生呼吸道感染增加。只有时间和进行更多的研究给我们答案。
