LIVERPOOL -- Life expectancy among patients with rheumatoid arthritis (RA) has increased dramatically over the past 25 years, a researcher reported here.
The average age at death for RA patients in a cohort that enrolled patients between 1986 and 1998 was 76.7 years (95% CI 75-78.1), while for a cohort that enrolled patients between 2002 and 2012, the average age of death was 86.7 (95% CI 84.1-89.5), according to , of King's College in London.
This represented a 3.5% decrease in relative hazard ratio for all-cause mortality every year between 1986 and 2012, he said at the
Since the 1980s, there has been an increase of at least 5 years in life expectancy in the general population, but it's been uncertain whether this has also been the case in RA. suggested that there had been no change in mortality rates over time.
To examine this in the national RA population in the U.K., Norton's group analyzed data from the Early Rheumatoid Arthritis Study (ERAS, 1986-1998) and the Early Rheumatoid Arthritis Network (ERAN, 2002-2012).
None of the patients had received disease-modifying anti-rheumatic drugs at the time of enrollment.
ERAS included almost 1,500 patients, and during almost 25,000 patient-years of follow-up there were 698 deaths. In ERAN, with 1,252 patients and 9,000 patient-years, there were 124 deaths.
Average duration of symptoms at the time of enrollment was 2 years in ERAS and 3 years in ERAN, and age at onset was 53 and 57, respectively.
Two-thirds were female in both groups.
The mean baseline disease activity score was 5.01 in ERAS and 4.53 in ERAN, Norton said. A possible reason for this slight decrease in disease activity in the later cohort was the greater use of steroids by primary care physicians before referral, he suggested.
Overall, there was a 27% decrease in excess all-cause mortality, which was mainly seen in patients younger than 55, he noted.
The standardized mortality ratio (SMR) in ERAS was 1.29 (95% CI 1.20-1.39), which was significantly higher than the general population, but no significant difference was seen for ERAN (SMR 0.94, 95% CI 0.78-1.13).
Similar trends were seen for death from cardiovascular causes, with the SMR in the earlier cohort being 1.96 (95% CI 1.64-2.39), decreasing to 1.11 (95% CI 0.75-1.46) in the later cohort.
Another difference was that in 1986, the average age at disease onset was 54.2 years, while in 2012, age at onset was 58.5, which was an increase of about 2 months each year (t=2.9, P=0.007).
"But to add a slightly negative note, it's important to recognize that if people are living longer, we need to think about disability," Norton said.
"A 10-year increase in life expectancy and a 5-year delay on onset suggests that on average, people are living 5 years longer with disability. So obviously there's good news but it's not all good," he said.
Disclosures
The authors disclosed no financial relationships.
Primary Source
British Society for Rheumatology
Source Reference: Norton S, et al "Excess mortality in rheumatoid arthritis: gains in life expectancy over 25 years" BSR 2014; Abstract O34.