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Wiley, Arthritis Care and Research, 9(66), p. 1296-1301, 2014

DOI: 10.1002/acr.22296

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Mortality Trends in Patients With Early Rheumatoid Arthritis Over 20 Years: Results From the Norfolk Arthritis Register

This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Data provided by SHERPA/RoMEO

Abstract

Objectives: To examine mortality rates in UK patients with early rheumatoid arthritis (RA) from 1990-2011, and compare with population trends. Methods: The Norfolk Arthritis Register (NOAR) recruited adults with ≥2 swollen joints for ≥4 weeks: cohort 1 1990-94, cohort 2 1995-99 and cohort 3 2000-04. At baseline, serum RF and ACPA were measured and the 2010 ACR/EULAR RA classification criteria applied. Patients were followed for 7 years, until emigration, or death. The UK Office for National Statistics notified NOAR of date and cause of deaths, and provided mortality rates for the Norfolk population. All-cause and cardiovascular specific standardised mortality ratios (SMRs) were calculated. Poisson regression was used to compare mortality rate ratios (MRRs) between cohorts then, with cubic splines, to model rates by calendar year. Analyses were performed in patients (i) with early inflammatory arthritis (EIA), (ii) classified as RA, and (iii) autoantibody positive. Results: 2519 patients were included: 1639 (65%) female, median age 55 years. 1419 (56%) fulfilled 2010 RA criteria. All-cause and cardiovascular SMRs were significantly elevated in the antibody positive groups. There was no change in mortality rates over time, after accounting for changes in the population rates. In RA patients all cause MRRs (95%CI), compared to cohort 1, were 1.13 (0.84-1.52) and 1.00 (0.7-1.43) in cohort 2 and 3 respectively. Conclusion: Mortality rates are increased in patients with RA and SMRs are particularly elevated in those who are autoantibody positive. Compared to the general population, mortality rates have not improved over the past 20 years. © 2014 American College of Rheumatology.