Association of Rheumatoid Arthritis With Postfracture Mortality and Fracture-Related Care

Rheumatoid arthritis (RA) is a potentially devastating autoimmune disease associated with multiple comorbidities, including osteoporosis and cardiovascular disease, which exert significant morbidity and mortality burdens. Despite the recognized connection between RA and fracture risk, few studies have evaluated postfracture survival in RA, and no studies have evaluated the effect of RA on postfracture survival between 1990 and 2010, when there was a rapid growth in disease-modifying antirheumatic drug (DMARD) availability in combination with a paradigm shift in the understanding of RA.

We performed a case-control matched retrospective cohort study of 1304 patients with RA, using routinely collected administrative health data from public and private hospitals in Western Australia, to assess survival after a first fracture.

We found that RA associated with a significant survival disadvantage after fracture (hazard ratio [HR] for death 1.28, 95% CI 1.18-1.39). In contrast to expectations, postfracture survival did not improve from 1990-1999 to 2000-2010 in patients with RA or in controls (HR: RA 0.95, 95% CI 0.75-1.20 vs controls 0.86, 95% CI 0.71-1.04). Further, we found that RA is a risk factor for increased episodes of hospital-based care (odds ratio 1.27, 95% CI 1.08-1.48).

Using data from hospitals in Western Australia, this study demonstrates that people with RA have worse survival after fracture, and, in contrast to expectation, this survival has not improved despite significant therapeutic advances over the past 40 years. Consequently, this study emphasizes the need to better understand and treat fractures in RA to improve the lives of these patients.