RESEARCH - Outcome after 40 years with RA: a prospective study of function, disease activity, and mortality

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J Rheumatol Suppl. 2004 Mar;69:3-8.

Outcome after 40 years with rheumatoid arthritis: a prospective study of

function, disease activity, and mortality.

Minaur NJ, y RK, Cosh JA, G, Rasker JJ.

Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom.

nicolaminaur@...

In an inception cohort of 100 patients with rheumatoid arthritis (RA) we

studied course and outcome after 40 years, regarding function, disease

activity, cause and age of death, and prognostic factors. Function,

joint count, erythrocyte sedimentation rate (ESR), hemoglobin (Hb),

rheumatoid factor (RF), and the number of orthopedic operations were

measured in 100 consecutive referrals between 1957 and 1963 with either

definite or classical RA at one year after onset of symptoms. Subjects

have been followed for a mean of 40 years, or until death. In May 1999,

84 subjects had died. Of the 16 survivors, 8 (50%) were severely

disabled from RA while 5 (31%) had normal function. The mean joint score

had gradually increased over 40 years. Death was directly attributable

to RA in 13, while RA or its treatment contributed to death in 11

subjects. In the other 60 deceased subjects, cardiovascular causes

accounted for 28 deaths (33% of total deaths). Features at one year that

were associated with mortality up to 40 years after onset by regression

analysis were: older age (p < 0.0001), lower Hb (p = 0.0461), and worse

function (p < 0.0001). The standardized mortality ratio of the cohort at

40 years was 2.13 (confidence interval 1.26-3.60), and median survival

was reduced by 10 years for men and 11 years for women compared to the

general population.

In conclusion, RA is a progressive disease impairing function up to 40

years after onset, with shortened life span. The leading cause of death

was cardiovascular disease.

PMID: 15053445

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15053445 & itool=iconabstr

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