Study: RA Increases Women's Mortality Risk By 40%
Women who have rheumatoid arthritis (RA) are at a significantly higher risk of all-cause mortality than women without the disease, according to a new study presented this week at the American College of Rheumatology Annual Meeting in Boston.
“We confirmed that RA is associated with 40% higher risk of mortality compared to women without RA, that is independent of mortality risk factors such as smoking and obesity,” says lead study author Jeffrey Sparks, MD, MMSc, of Brigham and Women’s Hospital in Boston.
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The researchers found that each 5 years of having RA increased the women’s mortality by 11% compared to women without the disease. Women with seropositive RA had a 51% higher risk of death compared to women without RA, whereas the mortality risk in seronegative RA was not statistically different from non-RA women.
Sparks and his colleagues evaluated mortality among women who were followed prospectively prior to RA diagnosis, directly comparing them to women without RA. They analyzed data from the Nurses’ Health Study, which included 121,700 women who were followed from 1976 to 2012.
Of those, they validated 964 incident cases of RA and identified 28,808 deaths in the entire cohort with 36 years of follow-up.
Of the 307 deaths among women with RA, 26% were from cancer, 23% from cardiovascular disease, and 16% from respiratory causes. In contrast, of the deaths among women without RA, 41% were from cancer, 22% were from cardiovascular disease, and 7% were from respiratory causes.
“We confirmed that cardiovascular mortality was increased by 45% in all RA patients, regardless of serotype,” Sparks says. “However, cancer-related deaths were similar between women with RA and women without RA.” Respiratory-related deaths are also a major concern in this patient population.
“We identified that women with seropositive RA have a nearly three-fold risk of respiratory-related death compared to women without RA, independent of smoking,” Sparks says. Respiratory deaths in women with RA were due to chronic obstructive pulmonary disease, pneumonia, chronic interstitial lung disease, asthma, and other respiratory diseases.
“Respiratory-related death is an underappreciated and significant contributor to RA mortality that deserves further research,” Sparks says. “Clinicians should be aware of this risk and perhaps screen symptomatic RA patients with pulmonary function tests or chest imaging.”
Sparks and his colleagues plan to conduct further studies to understand why respiratory-related death is increased in seropositive RA as well as identifying genetic or biomarkers that might predict mortality.
“We want to understand the factors that contribute to increased mortality in order to understand the modifiability of RA-related mortality,” Sparks says. “We would also like to perform research on other studies that include men in order to understand whether they have different risks.”
—Colleen Mullarkey
Reference
Sparks JA, Chang SC, Liao KP, Lu B, Solomon DH, Costenbader KH, et al. Incident rheumatoid arthritis and risk of mortality among women followed prospectively from 1976 to 2010 in the Nurses’ Health Study. Presented at: American College of Rheumatology Annual Meeting 2014, Boston. Nov. 15, 2014. Abstract 818.