DOES EXPOSURE TO IMMUNOSUPPRESSIVE THERAPY INCREASE THE 10 YEAR MALIGNANCY AND MORTALITY RISKS IN RHEUMATOID ARTHRITIS? A MATCHED COHORT STUDY

Rheumatoid arthritis (RA) is associated with increased mortalityand an increased risk of neoplasms of the immune system (NIM).To establish whether immunosuppressive therapy alters theserisks, a matched cohort study was conducted. The exposed cohortwere 259 RA patients, resident in the UK, who first receivedimmunosuppressive drugs (mainly azathioprine, cyclophosphamideand chlorambucil) between 1979 and 1982. The unexposed cohortwere 259 patients matched for age, sex and disease, residentin the USA, who had never received immunosuppressives. Bothcohorts had no prior reported malignancies and were followedfor 10 yr. There was a small increase in mortality in the exposedcompared to the unexposed cohort. Most of the excess deathswere due to malignancy. The relative risk (RR) of developingmalignancy [1.5 (95% CI 0.9–2.3)] was lower than the RRof dying from malignancy [4.2 (95% CI 1.7–10.0)]. TheRR of developing a NIM in the immunosuppressive-exposed groupwas 7.0 (95% CI 0.9–56.5). These results may be explainedin part by differences in cancer registration and death ratesbetween the UK and the USA. Nevertheless, the results suggestthat exposure to immunosuppressive therapy increases the 10yr malignancy risk in RA, but not mortality from other causes. KEY WORDS: Rheumatoid arthritis, Cancer, Mortality, Immunosuppressives, Matched cohort     

No increased mortality in patients with rheumatoid arthritis treated with biologics: results from the biologics register of six rheumatology institutes in Japan

Objective

To investigate the influence of biologics on mortality and risk factors for death in rheumatoid arthritis (RA) patients.

Methods

RA patients treated with at least one dose of biologics in daily practice in six large rheumatology institutes (“biologics cohort”) were observed until 15 May 2010 or death, whichever occurred first. Mortality of the biologics cohort and the “comparator cohort” (comprising patients among the IORRA cohort who had never been treated with biologics) was compared to that of the Japanese general population. Factors associated with mortality were assessed by a Cox model.

Results

Among 2683 patients with 6913.0 patient-years of observation, 38 deaths were identified in the biologics cohort. The probability of death in patients lost to follow-up, calculated using the weighted standardized mortality ratio (SMR), was 1.08 [95 % confidence interval (CI) 0.77–1.47] in the biologics cohort and 1.28 (95 % CI 1.17–1.41) in the comparator cohort. Pulmonary involvement was the main cause of death (47.4 %), and the disease-specific SMR of pneumonia was 4.19 (95 % CI 1.81–8.25). Risk factors for death included male gender [hazard ratio (HR) 2.78 (95 % CI 1.24–6.22)], advanced age (HR 1.07, 95 % CI 1.03–1.11), and corticosteroid dose (HR 1.08, 95 % CI 1.01–1.17).

Conclusion

Mortality in RA patients exposed to biologics did not exceed that in patients not exposed to biologics, but death from pulmonary manifestations was proportionally increased in RA patients exposed to biologics.     

Recent onset arthritis in the elderly: a 5 year longitudinal observational study

OBJECTIVE: To study the spectrum of diagnoses, course, and outcome of recent onset arthritis after the age of 60, presenting as rheumatoid arthritis (RA)-like disease. METHODS: A 5 year longitudinal observational study enrolled 92 consecutive patients (median age 73 yrs, 54/38 women/men, median duration of arthritis 12 weeks at inclusion). RESULTS: Forty-eight percent were classified as having RA according to the 1987 American Rheumatism Association criteria, 52% as non-RA (41.4% undifferentiated seronegative polyarthritis, 10.8% oligoarthritis with polymyalgic symptoms). Symmetrical involvement of small and medium size joints was more predominant in the RA (91 and 84%, respectively) than the non-RA patients (58 and 52%). The patients with RA compared to non-RA had more active and serious disease at onset, reflected by significant differences in number of swollen joints (median values 18 and 9, respectively), duration of morning stiffness (75 and 10 min), physician's global assessment of disease activity (45 and 28 mm on visual analog scale), and Health Assessment Questionnaire (HAQ) score for functional disability (1.8 and 1.0). Improvement during the course was observed in disease process variables as well as in HAQ disability score for both RA and non-RA patients. Risk factors for a poor 5 year functional outcome were female sex (OR 4.24), diagnosis of RA (OR 3.28), and baseline HAQ score > or =1.4 (OR 3.52). The median change in radiological progression (Larsen-Dale index) was zero. Twenty patients died during followup, the majority from cardiovascular diseases, infections, and malignancies. Mortality compared to the age and sex matched general population was increased for rheumatoid factor (RF) positive patients (standardized mortality ratio 272). Mortality risk factors within the patient cohort were male sex (OR 4.35), age (OR 1.17), and having RF+ RA (OR 11.93). CONCLUSION: Arthritis in the elderly is a heterogeneous group of arthritides with an overall favorable functional prognosis. The subgroup of women with elderly onset RA with functional disability at onset is at risk for a less favorable functional outcome. Mortality was increased for the patients with RF+ elderly onset RA only.     

In what sense is rheumatoid arthritis the principal cause of death? A study of the National Statistics Office's way of reasoning based on 1224 death certificates

Physicians' inadequacies in making out death certificates involving rheumatoid arthritis (RA) and the coders' reasons for not registering physicians' stated underlying cause as the underlying cause of death were investigated. The starting point of the study was a disagreement between physicians' reporting of RA on death certificates and the Swedish National Central Bureau of Statistics' (NCBS) registration of this condition, to the effect that the NCBS registered a 3.0-fold increase in mortality for women and a 2.7-fold increase for men attributed to RA between 1971 and 1975, whereas the physicians had reported practically no change at all for women and a slight decrease for men between the years. All Swedish RA death certificates for the years 1971 and 1975 were studied. A total of 1224 such certificates were identified. Four major qualifications for the coders to reject physicians' non-RA underlying cause, and for giving preference to RA in the registration of the underlying cause of death were discerned: RA appeared to have been favoured to the greatest extent by the NCBS (i) when RA was likely to have caused the reported underlying condition; (ii) when there is only one, non-RA, diagnosis reported in Part I of the certificate, and this diagnosis does not completely describe the train of events leading to death; (iii) when the diagnosis for the non-RA underlying condition provides less precise information about the site or nature of the underlying condition, compared with another diagnosis for another condition, RA, stated on the certificate; or (iv) when the reported non-RA underlying condition was unlikely itself to cause death, and was not reported as a cause of a more serious condition. The NCBS' increased registration of RA as the underlying cause of death between 1971 and 1975 could be explained neither by physicians' inadequacies in making out death certificates nor by a strict application of the international coding rules for registration of the underlying cause of death.     

Estrogen and other female reproductive risk factors are not strongly associated with the development of rheumatoid arthritis in elderly women

OBJECTIVE: Endogenous and exogenous reproductive hormones have been associated with rheumatoid arthritis (RA) in women, but data are inconsistent and no studies have assessed RA risk factors exclusively in elderly women. METHODS: The authors examined the association between reproductive factors, exogenous hormone exposure, and RA in a prospective cohort study of 31,336 Iowa women who were aged 55 to 69 years at cohort baseline in 1986. RESULTS: During 11 years of follow-up, 158 incident cases of RA were identified and validated. Age at last pregnancy (P trend =.01) and age at menopause (P trend =.03) were inversely associated with RA, whereas a history of polycystic ovary syndrome (relative risk [RR], 2.58; 95% confidence interval [CI], 1.06 to 6.30), endometriosis (RR, 1.72; 95% CI, 0.93 to 3.18), and former use of hormone replacement therapy (RR, 1.47; 95% CI, 1.04 to 2.06) were positively associated with RA. In multivariate analysis models, a history of polycystic ovary syndrome remained the most consistent predictor of RA, whereas the RRs for other factors attenuated. CONCLUSION: Few reproductive factors showed a strong or statistically significant association with RA in elderly women. The association of polycystic ovary syndrome may be indicative of perturbations of endocrine-immune activity that may influence the development of RA. This prospective cohort study adds to the understanding of the potential contribution of hormonal factors to the cause of RA in older women.     

SERUM CHOLESTEROL AND RISK OF RHEUMATOID ARTHRITIS IN A COHORT OF 52 800 MEN AND WOMEN

Recent epidemiological studies have suggested that joint riskfactors occur for rheumatoid arthritis (RA) and coronary heartdisease. We studied serum cholesterol concentration for itsassociation with the incidence of RA in 28 362 men and 24 444women free from arthritis at baseline. During a mean follow-upof 21 yr, 161 men and 351 women developed RA. Of these incidentcases, 119 men and 229 women were rheumatoid factor (RF) positive.The serum cholesterol concentration was directly proportionalto the risk of RF-positive RA among women and RF-negative RAamong men; the age-adjusted relative risks (95% confidence intervals)per S.D. (1.4mM/l) of the cholesterol distribution were 1.20(1.05–1.38) and 1.56 (1.15–2.10), respectively.No association was observed, however, for RF-negative RA amongwomen or RF-positive RA among men. The results suggest thata still unknown factor closely associated with serum cholesterolmay be involved in the aetiology of RA, but complex interactionswith sex and RF status seem to occur. KEY WORDS: Epidemiology, Longitudinal studies, Cholesterol, Rheumatoid arthritis, Rheumatoid factor, Risk factors     

High mortality in patients with rheumatoid arthritis and atlantoaxial subluxation.

OBJECTIVE: To study relationships between atlantoaxial subluxation (AAS) and total mortality in patients with rheumatoid arthritis (RA). METHODS: Radiological reports and clinical files of patients with RA were reviewed for the presence of cervical spine involvement verified by cervical radiographs. RESULTS: Among 241 patients with cervical radiographs, anterior AAS > or = 4 mm was found in 5% [95% confidence interval (CI) 2-8] of patients. Vertical and posterior subluxations were found in 1.4 and 0.5%, respectively. The mean observation time from RA diagnosis to AAS was 3.9 years. Patients with AAS had 8 times higher mortality than patients without AAS (95% CI 3-25). According to the death certificate, the patients died from cancer, stroke, and myocardial infarction. Cervical spine disorder was not mentioned on the death certificate. However, an autopsy was not performed. CONCLUSION: We found high mortality in RA patients with AAS. AAS in the cervical spine developed relatively early in the course of the disease. Analyses adjusted for seropositivity, erosiveness, and glucocorticosteroids did not reduce the mortality rate ratio. Our results underline the need for careful evaluation of patients with RA with respect to development of AAS.     

OUTCOME FROM MULTIPLE JOINT REPLACEMENT SURGERY TO THE LOWER LIMBS

All patients who had three or more major joints (hips or knees)replaced were identified from operation records at one hospitaland reviewed to assess outcome. Forty-three were found to sufferfrom rheumatoid arthritis, four from osteoarthritis and threefrom psonatic arthritis. Eight patients had died an average of 2.6 years (range 1–7years) after their last operation and this was higher than expected,even for RA. Average follow-up in the 36 surviving RA suffererswas 1.8 years, with a minimum of 6 months since last operation.Range of joint movement, pain relief, satisfaction, mobility,disability and social outcomes were assessed and are reported.Patients were satisfied with outcome because of pain reliefand functional improvement. No patient required permanent in-patientcare, although they still represented a very disabled groupwith mean HAO score of 2.75. KEY WORDS: Rheumatoid arthritis, Disability, Patient satisfaction, Social outcome, Mortality, HAQ     

Death certificate and mortality in rheumatoid arthritis

Patients with rheumatoid arthritis (RA), 500 males and 500 females, aged 40 years and over, together with an age- and sex-matched control population, were observed over a 10-year period. Altogether 208 male and 148 female RA patients died during the follow-up period. RA was mentioned on the death certificates of 111 men (53%) and for 96 women (65%). Serious underreporting of RA was observed when the main cause of death was malignant neoplasms and diseases of the circulatory system. The results show that analysis of the causes of death can be highly biased if the RA diagnosis is based only on information on the death certificate.     

Do breast-feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses' Health Study

OBJECTIVE: To explore the contribution of female hormonal factors occurring prior to the onset of rheumatoid arthritis (RA), such as age at menarche, parity, age at first birth, breast-feeding, use of oral contraceptives (OCs), irregular menstrual cycles, and postmenopausal hormone (PMH) use, to the subsequent development of RA in a large female cohort. METHODS: We studied female reproductive and hormonal risk factors for RA in a cohort of 121,700 women enrolled in the longitudinal Nurses' Health Study. The diagnosis of incident RA (between 1976 and 2002) in 674 women was confirmed by a connective tissue disease screening questionnaire and blinded medical record review for American College of Rheumatology criteria. Sixty percent of the patients with RA were rheumatoid factor positive. The relationship between potential risk factors, including age, age at menarche, parity, age at first birth, total lifetime history of breast-feeding, use of OCs, and irregular menstrual cycles and the multivariate-adjusted risk of RA was estimated using Cox proportional hazards models. RESULTS: Using a multivariate model that adjusted for age, body mass index, smoking, parity, and other hormonal factors, we observed a strong trend for decreasing risk of RA with increasing duration of breast-feeding (P for trend = 0.001). For women who breast-fed (compared with parous women who did not breast-feed), the risk ratios (RRs) and 95% confidence intervals (95% CIs) were as follows: breast-feeding for < or =3 total months, RR 1.0 (95% confidence interval [95% CI] 0.8-1.2); for 4-11 total months, RR 0.9 (95% CI 0.7-1.1); for 12-23 total months, RR 0.8 (95% CI 0.6-1.0); and for > or =24 total months, RR 0.5 (95% CI 0.3-0.8). Very irregular menstrual cycles were associated with an increased risk of RA (RR 1.4, 95% CI 1.0-2.0). Age at menarche < or =10 years was associated with an increased risk of seropositive RA (RR 1.6, 95% CI 1.1-2.4) but not significantly associated with risk of RA. Parity, total number of children, age at first birth, and OC use were not associated with an increased risk of RA in this cohort. CONCLUSION: In this large cohort, breast-feeding for >12 months was inversely related to the development of RA. This apparent effect was dose-dependent, with a significant trend toward lower risk with longer duration of breast-feeding. Irregular menstrual cycles and earlier age at menarche increased the risk of RA. Other reproductive hormonal factors were not associated with RA risk.     

The age of death of the parents of patients with rheumatoid arthritis: a preliminary study

The hypothesis was tested that the shortened life expectancy of patients with rheumatoid arthritis (RA) is, partially at least, due to a familial factor which independently shortens life expectancy, whether the person has RA or not. We therefore compared the ages of death of the parents of patients with RA with the ages of the death of the parents of a control group. The parents of the patients with RA had a mean age of death of 64.76; 18.23 years versus 68.29; 18.24 years for the parents of the control group (p = 0.006). This finding is compatible with the hypothesis: whether genetic or environmental factors are involved is unknown.     

Adverse reproductive outcomes in women who subsequently develop rheumatoid arthritis.

The rates of adverse reproductive outcomes in 40 women with rheumatoid arthritis (RA) were compared with 67 of their unaffected female relatives. All women were aged between 35 and 65 years at the time of inquiry. Seven of the women with RA reported a perinatal death (six stillbirths, one early neonatal death) compared with one women in the unaffected group: estimated age adjusted relative risk (R) = 12.4, 95% confidence interval (95% CI) 1.6-91.1. The rate of spontaneous abortions was, however, not significantly different between the two groups (R = 1.2, 95% CI 0.5-2.9). All the perinatal deaths occurred before clinical disease onset in the women with RA. It is possible that in these two groups of women with a similar genetic background perinatal loss may be related, at least in part, to disease expression.     

Mortality in rheumatoid arthritis: relationship to single and composite measures of disease activity

BACKGROUND: Rheumatoid arthritis (RA) is a heterogeneous disease characterized by a variable course of remissions and relapses. Single measures of disease activity at only one point in time may not reflect the overall control of disease activity. OBJECTIVE: The aim was to determine (i) the predictive value of 20 baseline demographic and disease variables on mortality, and (ii) the relationship between serial measures of the Stoke index (SI; a validated index of disease activity in RA) and mortality in RA. METHODS: Mortality in 309 RA patients followed up for a median of 14 yr was analysed retrospectively. The standardized mortality ratio (SMR) was calculated for all causes of death. The predictive values of baseline and time-integrated variables were assessed using multivariate Cox proportional hazards regression analysis. RESULTS: The SMR was 1.65. At baseline, only nodules, erosions, RA latex titre, white cell count and globulin level were predictive of mortality after correction for age, sex and disease duration. Using a stepwise Cox proportional hazards regression model, the most powerful predictors of mortality were age, nodules and RA latex titre. Individual measures of disease activity and the SI at baseline were not predictive of mortality. However, the mean level of the SI over 12 months was related to mortality (P=0.039). CONCLUSIONS: At baseline, the demographic and disease variables most significantly related to mortality in RA are age, nodules and RA latex titre. Individual measures of disease activity at a single point in time are poor predictors of mortality in RA. However, measurement of the mean level of disease activity over time using the composite SI has a significant relationship with mortality. A high level of sustained inflammation appears to be an important predictor of premature death.     

Association of menstrual and reproductive factors with pancreatic cancer risk in women: findings of the Japan Collaborative Cohort Study for Evaluation of Cancer Risk

Background The etiology of pancreatic cancer remains largely unknown. We examined the association of pancreatic cancer deaths with menstrual and reproductive factors in a cohort study involving Japanese women. Methods A total of 63 273 women were followed up for mortality from 1988 to 1999. Information on menstrual and reproductive factors was obtained by a questionnaire survey at baseline. Cox proportional-hazards models were used to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for death from pancreatic cancer in relation to menstrual and reproductive factors. Results During 631 401 person-years of follow-up, 154 women died from pancreatic cancer. Parity was not significantly associated with the risk of death from pancreatic cancer; the RR was 0.80 (95% CI, 0.31–2.11) for women with six or more births compared with women with zero or one birth. We found no significant overall association with other reproductive factors, including pregnancy, age at first birth, and menopause. The risk appeared to increase with increasing age at menarche; the RR was 1.49 (95% CI, 0.95–2.34) for women who had menarche after 16 years of age compared to those who had menarche before they were 15 years old. Conclusions Our prospective data indicate that menstrual and reproductive factors are not associated with the risk of death from pancreatic cancer among Japanese women.     

Estimating the extent of underreporting of mortality among HIV-infected individuals in Rio de Janeiro, Brazil

Non-HIV-related causes of death have been increasing after the introduction of highly active antiretroviral therapy. Underlying and contributing causes of death were assessed in respect to the presence/absence of HIV/AIDS among HIV-infected/AIDS patients in Rio de Janeiro, Brazil. Demographic variables (age, gender, ethnicity, and schooling) and CD4?cell counts closest to death were assessed through logistic regression models comparing those who did not have with those who had HIV/AIDS mentioned on the death certificate. The linkage with the two cohorts identified 1249 records, of which 370 (29.6%) did not have HIV/AIDS listed on any field of the death certificate [77 (20.8%) attributed to undefined and 72 (19.5%) to external causes]. After excluding external causes, 25.3% still did not have HIV/AIDS listed on the death certificate. Multiple logistic regression analysis showed that age >40 years (OR?=?2.09; 95%CI?=?1.49-2.93; p?相似文献   

Is poor pregnancy outcome a risk factor in rheumatoid arthritis?

Previous work has suggested that prior poor reproductive outcome may be a risk factor in rheumatoid arthritis (RA). A case-control study of 195 women with RA and 462 control women from two different sources is presented here. No increase in rates of spontaneous abortion was seen in the women with RA; indeed a protective effect was seen with an age adjusted odds ratio of 0.6 (95% confidence interval (CI) 0.4 to 0.9). A non-significant increase in stillbirth rates was seen in women with RA, producing an age adjusted odds ratio of 1.5 (95% CI 0.7 to 3.4). No differences in rates of induced abortion were seen. Thus although hormonal and gynaecological factors are undoubtedly important in the aetiology of RA, it was not possible to confirm that prior poor reproductive outcome is a risk factor in RA.     

How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease?

OBJECTIVE: To compare the proportion of the risk for the development of heart failure (HF) that is attributable to traditional cardiovascular (CV) risk factors, ischemic heart disease (IHD), and alcohol abuse between subjects with and subjects without rheumatoid arthritis (RA). METHODS: A population-based inception cohort of RA patients was assembled along with a similar cohort of subjects without RA. All individuals were followed up through their complete medical records, until HF incidence, death, migration, or January 1, 2001. The attributable risk of HF was estimated as the difference between the observed cumulative incidence of HF in each cohort (estimated from multivariable Cox models and adjusted for the competing risk of death) and the predicted cumulative incidence of HF in the absence of risk factors, with results expressed as a percentage of the observed cumulative incidence. RESULTS: A total of 575 RA subjects and 583 non-RA subjects (mean age 57 years, 73% women) without HF at incidence/index date had a mean followup of 15.1 and 17.0 years, respectively. During that period, 165 RA and 115 non-RA subjects had a first episode of HF, with a cumulative incidence of 36.3% and 20.4%, respectively, at age 80 years. Among non-RA subjects, 77% of the HF at age 80 years was attributable to CV risk factors, IHD, and alcohol abuse combined, whereas among RA subjects, only 54% of the HF at age 80 years was attributable to these factors (P < 0.01). CONCLUSION: The excess risk of HF among RA patients is not explained by an increased frequency or effect of CV risk factors and IHD.     

Very recent onset arthritis: the value of initial rheumatologist evaluation and anti-cyclic citrullinated peptide antibodies in the diagnosis of rheumatoid arthritis

The objective of this study is to identify baseline factors associated with rheumatoid arthritis (RA) diagnosis at the end of 1-year follow-up in a cohort of patients with very recent onset arthritis. Incident cases with self-reported arthritis (≤12 weeks) referred by primary care physicians were assessed by a designated rheumatologist who predicted in those with ≥1 swollen joint the diagnosis of RA at the end of follow-up. Patients were regularly seen and diagnosed through follow-up by staff rheumatologists who were blind to diagnostic prediction. Of 119 referrals, 78 (65.5%; age 35.5 ± 13.5 years; 69 females) were diagnosed at baseline as very recent onset arthritis (median duration 6 weeks (0–12 weeks)); of 75 patients completing 1-year follow-up, 51 (66.5%) were classified as RA; 12 (16%) had self-limited arthritis; and 13 (17.5%) other diagnoses. The characteristics of patients with RA as final diagnosis were polyarthritis, morning stiffness ≥1 h, high counts of swollen joints, and low frequency of systemic symptoms. Rheumatologist prediction of RA and anti-cyclic citrullinated peptide (anti-CCP) antibodies was strongly associated with RA as a final diagnosis in the logistic regression analysis. Sensitivity and specificity of the rheumatologist prediction were 94% and 74%, for anti-CCP antibodies, 56% and 96%; the combination of both variables had a specificity of 100% and a sensitivity of 53%, and a positive predictive value of 98%. The combination of RA as predicted diagnosis by a rheumatologist and anti-CCP antibodies is highly specific for RA diagnosis in patients with very early arthritis.     

Mortality in rheumatoid arthritis: have we made an impact in 4 decades?

OBJECTIVE: To evaluate trends in survival among patients with rheumatoid arthritis (RA) over the past 4 decades. METHODS: Three population based prevalence cohorts of all Rochester, Minnesota, residents age > or =35 years with RA (1987 American College of Rheumatology criteria) on January 1, 1965, January 1, 1975, and January 1, 1985; and an incidence cohort of all new cases of RA occurring in the same population between January 1, 1955 and January 1, 1985, were followed longitudinally through their entire medical records (including all inpatient and outpatient care by any provider) until death or migration from the county. Mortality was described using the Kaplan-Meier method and the influence of age, sex, rheumatoid factor (RF) positivity, and comorbidity (using the Charlson Comorbidity Index) on mortality was analyzed using Cox proportional hazards models. RESULTS: Mortality was statistically significantly worse than expected for each of the cohorts (overall p<0.0001). A trend toward increased mortality in the 1975 and 1985 prevalence cohorts compared to the 1965 prevalence cohort was present, even after adjusting for significant predictors of mortality (age, RF positivity, and comorbidity). Survival for the general population of Rochester residents of similar age and sex improved in 1975 compared to 1965, and in 1985 compared to 1975. CONCLUSION: The excess mortality associated with RA has not changed in 4 decades. Moreover, people with RA have not enjoyed the same improvements in survival experienced by their non-RA peers. More attention should be paid to mortality as an outcome measure in RA.     

Australian mortality statistics for rheumatoid arthritis 1950-81: analysis of death certificate data.

An analysis of mortality related to rheumatoid arthritis (RA) in Australia for the period 1950 to 1981 was undertaken based on information recorded in death certificates. These data include every death over a 32 year period where RA was considered to be the underlying cause. Death from RA was commonly reported (0.17% of all deaths). The mean age at death from RA in both sexes exceeded that of the general population for most of the period. There was little difference between patients dying of RA and the general population for age at death in the over 50 years' age group. There was a significant decrease in mortality for women dying of RA over the age of 75. RA accounted for more deaths in women than in men (in a ratio of 2.2:1). Men tended to die at a younger age from RA than did women. The impact of RA remained relatively constant in relation both to the total causes of death and to deaths due to other musculoskeletal diseases. There was a significant decline, however, in female RA deaths as a percentage of deaths due to all musculoskeletal diseases. Cohort analysis does not indicate any marked effect from extrinsic factors on mortality due to RA.