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Cardiovascular disease remains leading cause of mortality among patients with RA
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Results of a recently published study identified cardiovascular disease as the leading cause of death among patients with rheumatoid arthritis in São Paulo, Brazil, and highlighted infectious disease as an emerging cause of rheumatoid arthritis-associated death.
Researchers studied 3,629,559 death certificates issued in São Paulo issued between 1996 and 2010 and identified 3,955 that listed death related to rheumatoid arthritis (RA). Of these, 1,095 certificates listed RA as the underlying cause of death and 2,860 certificates listed the condition as the nonunderlying cause of death.
Death occurred after age 50 years in 90% of patients with RA. Seventeen patients were younger than 20 years at the time of their deaths, with four patients having RA as the listed underlying cause of death. The mean age of death was 67.1 years for patients with RA as the underlying cause and 67.9 years for patients with deaths in which RA was a nonunderlying cause.
Circulatory and respiratory system diseases were the most common causes attributed to death in cases with RA as the underlying cause (35.1% and 21.8%, respectively), followed by ischemic heart diseases (11.5%), cerebrovascular diseases (5.5%) and hypertensive diseases (4.2%). Unspecified organism pneumonia was the most common respiratory system disease, which was found in 9.4% of cases.
The most common deaths with RA as a nonunderlying cause were attributed to pneumonia (38.8%), sepsis (29.7%), renal failure (11.4%), interstitial lung disease (10.91%) and heart failure (9.1%). Linear regression showed a downward curve for RA-related deaths compared to an expected upward pattern in the general population.
“An unexpected early occurrence of RA-related deaths in the state of São Paulo was found. [Cardiovascular disease] CVD remained an important cause of death in RA, justifying a judicious follow-up and treatment of [cardiovascular] CV risk factors” the researchers wrote. “Infectious diseases are an important cause of death in patients with RA, raising the question of whether infections are related to more vigorous immunosuppressive treatment, as recommended by recent guidelines.” – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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