EDITORIAL - RF, smoking, and disease severity: associations with mortality in RA

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Journal of Rheumatology

Editorial

Jun 2008

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Rheumatoid Factor, Smoking, and Disease Severity: Associations with

Mortality in Rheumatoid Arthritis

NICOLA J. GOODSON, MBChB, MRCP, PhD,

Senior Lecturer in Rheumatology,

University Hospital Aintree, Liverpool University,

Liverpool, UK;

TRACEY M. FARRAGHER, MSc, PhD,

Research Fellow;

DEBORAH P.M. SYMMONS, MD, FFPH, FRCP,

Professor in Rheumatology and Musculoskeletal Epidemiology,

arc Epidemiology Unit, The University of Manchester,

Manchester, UK

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The majority of mortality studies published over the last 15 years

have identified excess mortality in rheumatoid arthritis (RA) cohorts

compared to that in the general population (Table 11-17), and many

have highlighted excess mortality from cardiovascular causes.

Methodology and study design seem to affect the magnitude of the

mortality rates, with community-based and inception-cohort followup

studies being associated with smaller increases in standardized

mortality ratios (SMR) than studies of established prevalent RA

cohorts. In this issue of The Journal, , et al explore

mortality rates in a population-based cohort of RA patients from

Rochester, Minnesota, USA, stratified by rheumatoid factor (RF)

status17. They report modest increases in SMR for RA patients who were

RF-positive, but found that patients with persistently RF-negative RA

had mortality rates similar to those in the general population. Other

studies have reported similar findings, with excess mortality being

observed only in the RF-positive patients in both hospital-based2 and

community-based cohorts5,18,19.

Within RA cohorts, RF positivity early in the disease course appears

to be a strong predictor of mortality. Van Schaardenburg, et al

demonstrated, in an inception cohort of 130 RA patients followed for a

mean of 5.6 years, that baseline RF-positive RA was associated with a

6-fold increased risk of mortality compared to those patients who were

RF-negative at baseline2. Conversely, RF-positive disease was not

associated with early mortality in a Norwegian cohort of patients with

RA20. However, many more studies have identified RF as a predictor of

mortality within RA cohorts1,3,14,15,21.

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