Differences in Cause-Specific Mortality in Patients With Rheumatoid Arthritis by Sex and Seropositivity

Area of Science:

• Rheumatology
• Epidemiology
• Public Health

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting joints and potentially other organs.
• Understanding mortality trends and risk factors in RA is crucial for patient management and public health strategies.

Purpose of the Study:

• To examine all-cause mortality trends in RA patients compared to expected rates.
• To investigate the impact of RA serostatus and sex on all-cause and cause-specific mortality.

Main Methods:

• A retrospective cohort study of RA patients and matched non-RA controls from Olmsted County, MN (1980-2019).
• Analysis included competing risks/cumulative incidence methods and Cox models to assess mortality risks.
• Investigated interactions between RA, sex, age, seropositivity, and calendar year.

Main Results:

• All-cause mortality was elevated in RA patients, particularly seropositive individuals, with a decline observed after the 1980s.
• A significantly higher risk of respiratory mortality was noted in seropositive RA patients (aHR 2.26) compared to seronegative RA patients (aHR 0.52).
• No significant sex-based differences in cause-specific mortality were found.

Conclusions:

• Seropositivity in RA is a significant risk factor for increased mortality, especially from respiratory causes.
• Seronegative RA patients do not exhibit an increased risk of death in this cohort.
• Findings highlight the importance of serostatus in predicting mortality outcomes in rheumatoid arthritis.