RESEARCH - Mortality in patients with RA treated with low-dose oral steroids. A population-based cohort study.

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J Rheumatol. 2006 Aug 1; [Epub ahead of print]

Mortality in Patients with Rheumatoid Arthritis Treated with Low-Dose Oral

Glucocorticoids. A Population-Based Cohort Study.

Sihvonen S, Korpela M, Mustonen J, Huhtala H, Karstila K, Pasternack A.

OBJECTIVE: To evaluate mortality and causes of death in patients with

rheumatoid arthritis (RA) treated with low-dose oral glucocorticoids.

METHODS:. Mortality was analyzed in population-based data of 604 patients

with RA. In the original study in 1988, state of general health, severity of

RA, and treatment including the use of oral glucocorticoids were recorded.

In 1999 vital status and causes of death were evaluated. Mortality in

patients with RA who had not received glucocorticoids (Group A, n = 209) was

compared to that in patients treated with glucocorticoids for less than 10

years (Group B, n = 276) or for more than 10 years (Group C, n = 119).

RESULTS: From onset of RA to 1999, 395 (65%) patients had been treated with

oral glucocorticoids. In 1999 a total of 160 (26%) patients had died, 23% of

patients in Group A, 21% in Group B, and 45% in Group C. In multivariate

regression analysis, male sex (hazard ratio 2.50; 95% CI 1.74-3.59),

impaired functional capacity by Health Assessment Questionnaire (HR 2.11;

95% CI 1.65-2.96), heart failure (HR 1.96; 95% CI 1.36-2.84), and diabetes

(HR 1.87; 95% CI 1.17-3.01) predicted increased mortality. In the same

analysis glucocorticoid treatment for 1 year increased the mortality risk by

14% (HR 1.14; 95% CI 0.98-1.27, p = 0.057) and treatment over 10 years by

69% (HR 1.69; 95% CI 1.12-2.56, p = 0.011) compared to RA patients without

treatment. The major cause of death was cardiovascular disease in all

groups, but infections and intestinal perforations due to amyloidosis were

more frequent in patients with long-lasting glucocorticoid therapy.

Lymphomas were more frequent in all patients treated with glucocorticoids

(Groups B and C) than in those not receiving glucocorticoids.

CONCLUSION: Patients with RA treated with low-dose oral glucocorticoids for

more than 10 years had increased mortality compared to those who did not

receive glucocorticoids or whose duration of treatment was less than 10

years. The increased mortality was related mainly to infections and

complications caused by systemic amyloidosis.

PMID: 16881099

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6881099

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