RESEARCH - SLE features in RA and their effect on overall mortality

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J Rheumatol. 2008 Nov 1. [Epub ahead of print]

Systemic Lupus Erythematosus Features in Rheumatoid Arthritis and

Their Effect on Overall Mortality.

Icen M, Nicola PJ, Maradit-Kremers H, Crowson CS, Therneau TM,

Matteson EL, SE.

From the Divisions of Epidemiology and Biostatistics, Department of

Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA;

Instituto de Medicina Preventiva, Faculdade de Medicina de Lisboa,

Lisbon, Portugal; and Division of Rheumatology, Department of

Medicine, Mayo Clinic.

OBJECTIVE: Features of systemic lupus erythematosus (SLE) are commonly

observed in patients with rheumatoid arthritis (RA). However, their

frequency and clinical significance are uncertain. We examined the

frequency of SLE features in RA and their effect on overall mortality.

METHODS: We assembled a population-based incidence cohort of subjects

aged >/= 18 years first diagnosed with RA [1987 American College of

Rheumatology (ACR) criteria] between 1955 and 1995. Information

regarding disease characteristics, therapy, comorbidities, and SLE

features (1982 ACR criteria) were collected from the complete

inpatient and outpatient medical records. regression models were

used to estimate the mortality risk associated with lupus features.

RESULTS: The study population comprised 603 subjects with incident RA

(mean age 58 yrs, 73% women) with a mean followup time of 15 years. By

25 years after RA incidence, >/= 4 SLE features were observed in 15.5%

of the subjects with RA. After adjustment for age and sex, occurrence

of >/= 4 SLE features was associated with increased overall mortality

[hazard ratio (HR) 5.54, 95% confidence interval (CI) 3.59-8.53]. With

further adjustment for RA characteristics, therapy, and comorbidities,

the association weakened but remained statistically significant (HR

2.56, 95% CI 1.60-4.08). After adjustment for age, sex, RA

characteristics, therapy, and comorbidities, thrombocytopenia (2.0,

95% CI 1.2, 3.1) and proteinuria (1.8, 95% CI 1.3, 2.6) were

significantly associated with mortality.

CONCLUSION: SLE features were common in RA, given sufficient

observation time. Subjects with RA who developed >/= 4 SLE features

had an increased risk of death. Proteinuria and thrombocytopenia were

individually associated with an increased mortality risk.

PMID: 19004043

http://www.ncbi.nlm.nih.gov/pubmed/19004043

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