Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Respiratory Cause Mortality Was Greater in 54 Incident Rheumatoid Arthritis (RA) Patients Than 204 Community-Based, Non-RA Matched Cohort Controls (CN).

Masi,  Alfonse T., Aldag,  Jean C.

Purpose:

Mortality from interstitial lung disease (ILD) is known to be increased in RA (Bongartz T et al. A&R 2010; 62: 1583-91). This study aimed to analyze non-malignant respiratory cause mortality in incident RA cases from a prospective, community-based cohort, and as compared to matched non-RA CN.

Design:

The 54 cases studied had onset of ACR-positive RA, 3 to 20 (mean 12) years, after entry into the cohort (n = 21,061 adults) in 1974. RAs were matched by age, gender, and race (all Caucasian) at baseline with 204 cohort non-RA CN. All study subjects (n=258) had baseline (1974) data on: demographic variables; cigarette smoking, and immunological testing on stored (-70°C) sera. A novel baseline biomarker predicted cohort mortality (data separately submitted), consisting of upper quartile values of acute-phase serum amyloid A (A-SAA) or serum interleukin-2 receptor alpha (sIL-2Ra). Each RA was also grouped in 1995 by the sole community rheumatologist into 3 course-wide therapy responses: 1 =full; 2 =moderate, and 3 =limited, (data separately submitted). Deaths from primary non-malignant respiratory causes (ICD-9, 460–519 & ICD-10, J00-J99) were analyzed, over 1992–2009. Hazard ratio (HR) for respiratory cause mortality was estimated using Cox regression models, adjusting for covariates.

Results:

Deaths from non-malignant respiratory causes occurred in 8 (15%) of 54 RA vs 10 (5%) of 204 non-RA, OR = 3.37 (95% CI 1.30 – 8.79), p = 0.017. None of the 8 RA had deceased from chronic airway disease (ICD-9 496 or ICD-10 J44.9) or pulmonary edema (ICD-9 518.4 or ICD-10 J81), unlike 5 of the 10 respiratory deaths in non-RA CN (p = 0.036). Respiratory deaths occurred in 4 (22%) of 18 male RA, and 4 (11%) of 36 female RA. Three of the 4 males who had respiratory deaths were treated in 1995 with oral methotrexate (MTX) doses of 20+ mg weekly and with predisone (Pred) doses of 10+ mg daily vs only 1 of the remaining 14 male RA (p = 0.019). Only 2 of 4 female RA respiratory deaths had received low-dose MTX (7.5 mg/wk) and prednisone (5 mg/d) therapy, similar to the other 32 female RA. Respiratory cause mortality was greater in RA than non-RA (HR=2.88, 95% CI 1.06–7.82), after adjusting for cohort entry age (p = 0.027), baseline heavy cigarette (30+ daily) smoking (p = 0.018), limited therapy responses (p = 0.033), and the biomarker (p = 0.056). Mean (± 1 SE) features of the 8 RA deceased from respiratory causes vs the other 46 RA are shown (Table 1):

8 Respiratory Deaths vs 46 Other RA CasesAge at RA Onset (X ± SE)Age in 1995 (X ± SE)Last Age At Follow (X ± SE)Baseline Cigs/Day (X ± SE)1995 Pred mg/d (X ± SE)1995 MTX mg/wk (X ± SE)
18 Male RA 
  4 Respiratory52.0 ± 4.957.8 ± 5.270.0 ± 5.318.8 ± 7.213.1 ± 2.818.1 ± 3.7
  14 Other RA55.1 ± 2.764.0 ± 2.274.5 ± 2.020.3 ± 6.03.0 ± 1.78.0 ± 3.5
36 Female RA 
  4 Respiratory51.8 ± 2.464.5 ± 3.371.6 ± 1.911.3 ± 7.22.5 ± 1.43.8 ± 2.2
  32 Other RA56.1 ± 2.464.8 ± 2.374.7 ± 1.910.4 ± 2.33.8 ± 0.75.5 ± 1.1

Conclusions:

Respiratory deaths were greater (p = 0.036) in incident RA (15%) than non-RA (5%), especially after excluding chronic airway disease and pulmonary edema (p = 0.001). Respiratory mortality was increased in RA after adjusting for multiple relevant covariates. Respiratory cause mortality of RA patients deserves further prospective study.

To cite this abstract, please use the following information:
Masi, Alfonse T., Aldag, Jean C.; Respiratory Cause Mortality Was Greater in 54 Incident Rheumatoid Arthritis (RA) Patients Than 204 Community-Based, Non-RA Matched Cohort Controls (CN). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :83
DOI: 10.1002/art.27852

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