Women with Rheumatoid Arthritis Face Higher Mortality Risk

Risk of death in patients with cardiovascular and respiratory conditions amplified in female patients with rheumatoid arthritis.

Women suffering from rheumatoid arthritis (RA) face a significantly greater mortality risk, which is magnified in patients with cardiovascular and respiratory conditions.

Researchers analyzed the recent Nurses’ Health Study, which provided an extensive amount of data on patients at various timeframes following RA diagnosis. The data revealed a significant mortality risk in women with the condition.

“Previous studies have suggested that RA may be associated with increased mortality, but were not able to control for other variables, such as smoking, that affect both RA and mortality risks,” said corresponding author Jeffrey Sparks, MD, MMSc.

The study, published recently in Arthritis Care & Research, included data as far back as 1976 from 119,209 women. None of the patients in the study had connective tissue disease, however 964 women in the analysis were diagnosed with RA.

During the 36-year follow-up, 28,808 deaths occurred, of which 307 patients had RA. The causes of death included 80 patients (26%) who died of cancer, 70 patients who died of cardiovascular disease (23%), and 44 patients (14%) who died of respiratory issues.

Researchers accounted for characteristics such as age, smoking, diet, physical activity, and body mass index. Despite these risk factors, RA remained an independent factor.

The significant increase in mortality risk was not linked to cancer, but was instead associated with respiratory and cardiovascular conditions. The hazard risks were 2.06 in respiratory conditions, 1.45 for cardiovascular conditions, and 0.93 for cancer.

Researchers noted a 95% confidence interval in the findings.

“We finely adjusted for smoking in our analyses so what we’re seeing appears to be due to something else,” Sparks said.

The analysis showed this other cause was RA, which carried a 40% increased mortality risk for these patients.

Seropositive patients, who show anti-cyclic citrullinated peptides (anti-CCPs) in a blood test, carry a greater chance of developing more severe RA compared with patients who test as seronegative. The results of the study confirmed a difference between these 2 types of patients.

“We found that whether participants with RA were seropositive or seronegative really mattered — those who were seropositive were at higher risk, particularly for respiratory mortality,” Sparks noted.

Specifically, the results showed a 3-fold increased relative risk for seropositive patients compared with patients who do not have RA.

“We hope that this study will encourage patients and clinicians to be more aware that patients with RA are at increased risk of both respiratory and cardiovascular mortality, particularly patients with seropositive RA,” Sparks concluded.