All-cause and cause-specific mortality in rheumatoid arthritis: ameta-analysis.

Abstract

This study aimed to evaluate standardized mortality ratios (SMRs) for both all-cause and cause-specific mortality in patients with rheumatoid arthritis (RA). We conducted an extensive search across the Medline, Embase, and Cochrane databases to identify studies investigating SMRs for all-cause and/or cause-specific mortality in individuals with RA compared to the general population. Subsequently, we performed acomprehensive meta-analysis, examining SMRs across various categories, including all-cause, sex-specific, ethnicity-specific, and cause-specific SMRs in RA patients. Seventeen studies involving 486,098patients with RA and 63,988deaths met the inclusion criteria. Patients with RA had a1.522-fold increase in all-cause SMR (SMR 1.522, 95% CI 1.340-1.704, p < 0.001) compared to the general population. Stratification by ethnicity revealed that the all-cause SMR was 1.575 (95% CI 1.207-1.943) in Caucasians and 1.355 (95% CI 1.140-1.569) in Asians. The gender-specific meta-analysis revealed elevated SMR in both women and men. RA patients exhibited an increased risk of mortality attributed to cardiovascular disease (CVD), respiratory disease, infection, and cerebrovascular accidents (CVA). However, no significant increase in SMR was observed for mortality due to malignancy. This meta-analysis study highlights a1.522-fold increase in SMR in patients with RA compared to that in the general population, irrespective of sex or region. Additionally, anotable increase in mortality associated with specific causes, including CVD, respiratory disease, infection, and CVA, underscores the critical need for targeted interventions to manage these heightened risks in patients with RA.