Improved treatment strategies reduce the increased mortality risk in early RA patients

A higher mortality rate in patients with RA than in the general population has been reported in most series. Treatment strategies for RA have improved dramatically over the last decades, resulting in less inflammation and joint damage. We investigated whether this change in treatment corresponds to reversal of excess mortality by studying a large inception cohort of early RA patients exposed to different treatment strategies.

Six hundred and eighty-four RA patients included in the Leiden Early Arthritis Clinic between 1993 and 2008 were studied. Treatment was different for three inclusion periods. From 1993 to 1995 patients were treated with NSAIDs and only late in their disease with DMARDs. From 1996 to 1998 patients were promptly treated with HCQ or SSZ. From 1999 to 2008 patients were immediately treated with MTX monotherapy or in combination with other disease-modifying drugs. Life/death status was tracked nationally using the civic registries. Mortality rates were compared with the general Dutch population.

In Periods 1 and 2, increased standardized mortality rates were found, 1.35 (95% CI 0.94, 1.93) and 1.23 (95% CI 0.91, 1.67), respectively, while a decreased standardized mortality rate was found for patients included in 1999-2006 [0.49 (95% CI 0.31, 0.77)]. Age of onset [hazard ratio (HR) 1.10 (95% CI 1.07, 1.13)], erosive disease [HR 2.03 (95% CI 1.22, 3.37)], high CRP level [HR 1.09 (95% CI 1.01, 1.18)], smoking [HR 2.39 (95% CI 1.31, 4.38)] and higher baseline HAQ score [HR 1.53 (95% CI 1.06, 2.20)] associated with mortality.

Current treatment strategies for early RA, such as that given in inclusion Period 3, might contribute to the reversal of excess mortality in RA.