Mortality In Rheumatoid Arthritis Patients Research Articles

Association of urinary albumin excretion with all-cause and cardiovascular mortality among patients with rheumatoid arthritis: a national prospective study.

Rheumatoid arthritis (RA) patients suffering from chronic renal insufficiency tend to exhibit subtle manifestations at the beginning. Urine albumin to creatinine ratio (ACR) is a sensitive indicator for early assessment of renal function. However, it is unclear whether it serves as an independent risk factor influencing the prognosis of RA patients. National Health and Nutrition Examination Survey (NHANES) data from 2009-2018 were included. Kaplan-Meier (K-M) curves were plotted to compare the cumulative survival probability of RA patients with different urinary albumin excretion. The association of ACR with mortality among RA patients was investigated with Cox regression model, restricted cubic spline (RCS) and stratified analyses. The prognostic efficacy of ACR and estimated glomerular filtration rate (eGFR) was evaluated by receiver operating characteristic (ROC) curves. The Cox regression model adjusted with covariates showed a 53% (HR 1.53, 95% CI 1.06-2.21) increase in all-cause mortality and a statistically non-significant increase in cardiovascular disease (CVD) mortality in RA patients with microalbuminuria (30mg/g ≤ACR<300mg/g). ACR≥300mg/g was associated with an increase in all-cause mortality (HR 2.62, 95% CI 1.55-4.45) and CVD mortality (HR 5.67, 95% CI 1.96-16.39). RCS demonstrated a nonlinear correlation between ACR and all-cause mortality in RA patients with microalbuminuria. Subgroup analysis showed that CVD mortality was higher in RA patients with microalbuminuria characterized by the following features: female, other ethnicity, eGFR≥60 ml/min/1.73 m2, hypertension or hyperlipidemia. Compared with eGFR, ACR provided better prognostic efficacy than eGFR with higher values of the area under the curve (AUC) for all-cause mortality (AUC=0.683, 95% CI 0.613-0.754) and CVD mortality (AUC=0.681, 95% CI 0.541-0.820). ACR is an independent risk factor affecting the prognosis of RA patients. The all-cause mortality was increased in RA patients with albuminuria. There was an upward trend in the CVD mortality of those with macroalbuminuria when ACR increased.

Association of Vitamin E Intake with All-Cause Mortality Among Individuals with Rheumatoid Arthritis: A Cohort Study from the NHANES 1999-2018

Background The relationship between dietary vitamin E intake and mortality rates among rheumatoid arthritis (RA) patients remains a relatively uncharted territory in nutritional epidemiology, underscoring an important gap in research. Objectives This study is to explore the potential association between dietary vitamin E intake and all-cause mortality in the RA patient population. Methods This longitudinal cohort study analyzed 2,906 RA patients aged 20 years or older who participated in the National Health and Nutrition Examination Survey from 1999 to 2018. Comprehensive data on mortality, dietary vitamin E intake, and pertinent confounding variables were systematically collected and analyzed using Cox regression and spline curve fitting to analyze the potential association. Results Following the adjustment for confounding factors, a significant inverse relationship was identified between dietary vitamin E intake and the risk of all-cause mortality in patients with RA. The adjusted hazard ratios (HRs) for the second (Q2), third (Q3), and fourth (Q4) quartiles of vitamin E intake were 0.85, 0.60, and 0.68, respectively. Non-linear modeling indicated a threshold effect characterized by a curve that associated dietary vitamin E intake with mortality risk (p = 0.016). An intake threshold of 7.097 mg/day was identified, below which each unit increment in vitamin E intake was associated with a 11.1% decrease in all-cause mortality risk (HR = 0.889). Conversely, for intakes surpassing this threshold, no significant relationship with mortality risk was detected (HR = 1.0038). Conclusion The findings of this study indicate a beneficial relationship between elevated dietary vitamin E intake and a reduced risk of all-cause mortality in RA patients. The dose-response relationship exhibits a non-linear pattern, featuring a critical inflection point at an intake of approximately 7.097 mg/day.

Red cell distribution width/albumin ratio and mortality risk in rheumatoid arthritis patients: Insights from a NHANES study.

Despite the established negative regulatory effects observed in various diseases like cardiovascular disease and diabetes, the distinct impact of red cell distribution width (RDW) to albumin ratio (RAR) on mortality within the realm of rheumatoid arthritis (RA) remains obscure. This study sought to explore the relationship between RAR and mortality in RA patients. A cohort of 2151 adults with RA from the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2016 was analyzed for RAR levels derived from red cell distribution width and albumin concentrations. Utilizing Cox regression analysis, Kaplan-Meier curves, and Restricted Cubic Spline (RCS) models, we assessed the association between RAR levels and RA mortality while adjusting for potential confounding variables. Participants with higher RAR had a twofold to threefold increased risk of all-cause (HR = 3.10, 95% CI: 2.26-4.24) and cardiovascular mortality (HR = 2.46, 95%CI: 1.26-4.79) versus lower RAR. Kaplan-Meier analysis revealed that the higher RAR group had a significantly lower survival rate compared to the lower RAR group for both all-cause and cardiovascular mortality (both p < .0001), with a more pronounced effect observed for all-cause mortality. Furthermore, the RCS-fitted Cox regression model illustrated a nonlinear positive correlation between RAR levels and RA mortality. Overall, a higher RAR was associated with an increased risk mortality in RA patients. These findings underscore the potential of RAR as a prognostic biomarker in predicting outcomes in RA.

Nonlinear associations of systemic immune-inflammation index with all-cause and cardiovascular mortality in US adults with rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease. However, the relationship between the systemic immune-inflammation index (SII) and the prognosis of RA patients remains unclear. This study aimed to investigate the association between inflammatory biomarker SII and all-cause and cardiovascular mortality in RA patients. A retrospective analysis was conducted using data from the National Health and Nutrition Examination Survey database spanning from 1999 to March 2020. We assessed the association between the SII and all-cause as well as cardiovascular mortality in RA patients employing multivariable Cox proportional hazards regression analysis and restricted cubic spline plots. Receiver operating characteristic curves were employed to evaluate the prognostic capacity of SII in predicting outcomes in both the RA patients and the general population, alongside its predictive performance compared to other markers. This study comprised 2247 RA patients and a control cohort of 29,177 individuals from the general population. Over a 20-year follow-up period, 738 all-cause deaths and 215 deaths attributable to cardiovascular disease were documented in RA patients. We observed a nonlinear positive correlation between the SII and both all-cause and cardiovascular mortality in RA patients. Of significance, at an SII level of 529.7, the hazard ratio reached 1, signifying a transition from low to high mortality risk. Moreover, subgroup analysis did not reveal any potential interactions. Our study findings indicate a nonlinear positive correlation between the inflammatory biomarker SII and both all-cause and cardiovascular mortality in patients with RA.

Analysis of Potential Vitamin D Molecule Biomarkers: Association of Calcitriol and Its Hydroxylation Efficiency Ratio with Cardiovascular Disease Risk in Rheumatoid Arthritis Patients.

Rheumatoid arthritis (RA) is a multifactorial autoimmune disease in which hypovitaminosis D by calcidiol quantification has been associated with disease severity. However, other vitamin D molecules could be implicated in RA pathophysiology and its comorbidities such as cardiovascular disease (CVD), which impacts the severity and mortality of RA patients. This study aimed to assess the relationship between calcidiol, calcitriol, its hydroxylation efficiency ratio, and the soluble vitamin D receptor (sVDR) and clinical and CVD risk variables to propose potential vitamin D molecule biomarkers for RA. A cross-sectional study of females was conducted on 154 RA patients and 201 healthy subjects (HS). Calcidiol, calcitriol, and the sVDR were measured in blood serum, and vitamin D hydroxylation efficiency was estimated using the calcitriol/calcidiol ratio score. CVD risk was calculated by the high-sensitivity C-reactive protein (hs-CRP) cutoff values. Disease activity was evaluated with the Disease Activity Score for 28 standard joints (DAS28-CRP). Results: The hydroxylation efficiency ratio and calcitriol serum levels were higher in RA patients with hypovitaminosis D (p < 0.001). Moreover, RA patients had a higher probability of a high hydroxylation efficiency ratio (OR = 2.02; p = 0.02), calcitriol serum levels (OR = 2.95; p < 0.001), and sVDR serum levels (OR = 5.57; p < 0.001) than HS. This same pattern was also observed in RA patients with high CVD risk using CRP serum levels; they showed a higher hydroxylation efficiency ratio (OR = 4.51; p = 0.04) and higher calcitriol levels (OR = 5.6; p < 0.01). Calcitriol correlates positively with the sVDR (r = 0.21, p = 0.03), CRP (r = 0.28, p < 0.001), and cardiometabolic indexes (p < 0.001) also showed discrimination capacity for CVD risk in RA patients with CRP ≥ 3 mg/L (AUC = 0.72, p < 0.01). In conclusion, hypovitaminosis D in RA patients was characterized by a pattern of a higher hydroxylation efficiency ratio and higher calcitriol and sVDR serum levels. Notably, higher calcitriol serum levels and a higher vitamin D hydroxylation efficiency ratio were associated with higher CVD risk in RA patients.

Association between metabolic score for insulin resistance and cardiovascular disease mortality in patients with rheumatoid arthritis: evidence from the NHANES 1999-2018.

To explore the association between Metabolic Score for Insulin Resistance (METS-IR) and the risk of cardiovascular disease (CVD) death in patients with rheumatoid arthritis (RA). This retrospective cohort study extracted data on 1,218 RA patients from the National Health and Nutrition Examination Survey. The weighted univariate and multivariate Cox regression model was established to explore the association between METS-IR and CVD mortality. Subgroup analysis was performed in terms of age, gender, body mass index, diabetes, and CVD. Hazard ratios (HRs) and 95% confidence levels (CIs) were presented. Increased METS-IR was associated with a significantly higher risk of CVD mortality (HR=4.59, 95%CI: 1.98-10.67), and METS-IR>2.48 was associated with higher odds of CVD mortality compared with METS-IR ≤ 2.25 (HR=3.57, 95%CI: 2.04-6.24). METS-IR was positively associated with the risk of CVD mortality (HR=3.83, 95%CI: 1.62-9.08), and METS-IR>2.48 was associated with a significantly higher risk of CVD mortality in contrast to METS-IR ≤ 2.25 (HR=3.38, 95%CI: 1.87-6.09). Increased METS-IR was associated with a significantly higher risk of CVD mortality in RA patients. Clinicians could consider incorporating the METS-IR score into routine assessment of the prognosis of RA patients.

Association of advanced lung cancer inflammation index with all-cause and cardiovascular mortality in US patients with rheumatoid arthritis.

As a systemic autoimmune disorder, the prognosis of rheumatoid arthritis (RA) is intricately linked to inflammation. This study aimed to investigate the association between the advanced lung cancer inflammation index (ALI), a comprehensive indicator of inflammation combined with nutritional status, and all-cause and cardiovascular mortality among patients diagnosed with RA. The 2,305 RA patients from NHANES (2001-2018) included in the analysis were categorized into three groups according to ALI tertiles. Weighted Kaplan-Meier and multivariate COX regression analyses evaluated the relationship between ALI and mortality. The time-dependent characteristic curve (ROC) was used to assess the prediction accuracy of ALI. During a median follow-up of 7.92 years, 591 participants died from all causes, including 197 from cardiovascular diseases. Increased ALI was associated with a decreased probability of death. The full COX model revealed lower all-cause mortality hazard risks in the T2 (HR: 0.67, 95%CI: 0.54-0.83) and T3 (HR: 0.47 95%CI: 0.33-0.67, p for tend <0.001) groups compared to T1, and the risk of cardiovascular mortality was also lower in the groups of T2 (HR: 0.47, 95%CI: 0.31-0.70) and T3 (HR: 0.34, 95%CI: 0.19-0.62, p for trend <0.001). Furthermore, the ROC analysis underscored the strong predictive capability of ALI (AUC for 1-year all-cause and cardiovascular mortality were 0.73 and 0.79, respectively). This cohort study demonstrated the higher accuracy of ALI in predicting mortality in RA patients, highlighting the important clinical value of ALI in risk assessment and prognosis evaluation.

Association between Life's Essential 8 and all-cause or cardiovascular-specific mortality in patients with rheumatoid arthritis.

Patients with rheumatoid arthritis (RA) have been found to have a higher cardiovascular disease (CVD) burden. We aimed to examine the associations between Life's Essential 8 (LE8), a metric of cardiovascular health (CVH) recently proposed by the American Heart Association, and all-cause and CVD mortality in RA patients. This prospective cohort study analysed RA patients from the National Health and Nutrition Examination Survey 2005-2018 with linked mortality data through December 31, 2019. Total LE8 scores were calculated and divided into the high- (LE8 80-100), moderate- (LE8 50-79), and low-CVH (LE8 0-49) groups. Weighted multivariable Cox regression, logistic regression and restricted cubic spline models were applied to explore the association between LE8 and outcomes. A total of 1424 RA patients were enrolled with a weighted mean age of 57.87 years and female proportion of 58.94%. During a median follow-up of 82 months, 270 all-cause (85 CVD) deaths were recorded. Compared with the high-CVH group, participants in the moderate- and low-CVH groups had an 85.8% and 129.5% increased risk of all-cause mortality, respectively. After adjustment for potential confounders, each 1 point decrease in LE8 score was associated with a 2.6% increased risk of CVD mortality. Subgroup analyses showed significant interactions between LE8 score and non-Hispanic white population with risk of all-cause mortality. The results were robust for all-cause mortality, but not for CVD mortality in the sensitivity analysis. CVH measured by the LE8 score is a robust and independent predictor of all-cause mortality among U.S. RA patients.

Pathogenesis of Extraarticular Manifestations in Rheumatoid Arthritis-A Comprehensive Review.

Rheumatoid arthritis (RA) is among the most prevalent and debilitating autoimmune inflammatory chronic diseases. Although it is primarily characterized by destructive peripheral arthritis, it is a systemic disease, and RA-related extraarticular manifestations (EAMs) can affect almost every organ, exhibit a multitude of clinical presentations, and can even be asymptomatic. Importantly, EAMs largely contribute to the quality of life and mortality of RA patients, particularly substantially increased risk of cardiovascular disease (CVD) which is the leading cause of death in RA patients. In spite of known risk factors related to EAM development, a more in-depth understanding of its pathophysiology is lacking. Improved knowledge of EAMs and their comparison to the pathogenesis of arthritis in RA could lead to a better understanding of RA inflammation overall and its initial phases. Taking into account that RA is a disorder that has many faces and that each person experiences it and responds to treatments differently, gaining a better understanding of the connections between the joint and extra-joint manifestations could help to create new treatments and improve the overall approach to the patient.

Scleritis in rheumatoid arthritis: Before and during biologic era.

Scleritis represents a severe extra-articular manifestation of rheumatoid arthritis (RA). Recent clinical observations suggest a decreasing incidence of scleritis in RA, attributed to improved treatment options. Our study reports on the incidence and clinical characteristics of scleritis in RA observed in the biological era and reflects on our results in a historical perspective. We performed a retrospective evaluation of all 1623 consecutive patients with RA diagnosed at the department of rheumatology between 2011 and 2021 at the Erasmus Medical Center to investigate the incidence of scleritis. We also reviewed clinical and laboratory data of all patients with scleritis and RA from the department of ophthalmology at our center. In addition, we reviewed the literature on this topic and discuss our results in view of changes over time. The incidence of scleritis within recent series of patients with a diagnosis of RA in our tertiary center was 0,25% in 10 years (4 out of 1623; 2011-2021).The cumulative incidence of scleritis in RA based on literature review from the pre-biologic era varied from 0.7% per 8 years to 0,8% per 30 years. Manifestations and complications of scleritis remained unchanged over time, with scleral necrosis developing in more than 80% of cases and mortality of RA patients with scleritis remained similar to pre-biologic era (30% in 9 years after the onset of scleritis). The RA patients with scleritis often exhibited autoantibodies (rheumatoid factor and/or anti-citrullinated protein antibody) and erosive disease. Although our recent series is characterized by a slightly lower incidence of scleritis in RA compared to the pre-biologic era, clinical presentation remained severe and similar to the pre-biologic era. Ophthalmologists and rheumatologists should be aware of scleritis as a severe extra-articular manifestation of RA.

RA-associated atherosclerosis: mechanisms of development and therapeutic perspectives

According to data from large population trials and meta-analyses, mortality in rheumatoid arthritis (RA) significantly exceeds that in the general population. Cardiovascular diseases (CVD) rather widely contribute to the excess mortality in RA patients. Despite the recent emergence of a large number of innovative drugs for RA treatment, CVD mortality in this pathology persists at the level of the cardiovascular risk (CVR) typical for diabetes mellitus. With that, currently there is a clear trend among physicians for underestimating CVR in these patients. The review analyzes discovered pathogenetic mechanisms of CVR development in RA, which are represented by an integrated complex of vascular (endothelial dysfunction), cellular (T-cell dysfunction), and humoral (proinflammatory mediators, autoantibodies, complement activation) disorders. Besides, despite a large amount of disease-modifying antirheumatic drugs that can provide CVR decrease due to selective effects on separate mechanisms, the current lack of comparative trials does not allow to readily define specific drugs that are beneficial for the specific CVD decrease. Due to this, the promising trend of applied clinical medicine presumes the implementation of the interdisciplinary approach to CVR correction in RA patients, which will account not only for the treatment administered by the rheumatologist, but also the risk stratification, patient compliance, and multidisciplinary treatment efficacy control. This will allow for optimal CVD prevention in RA patients, thus significantly improving their quality of life and prognosis.

Impact of the malnutrition on mortality in Rheumatoid arthritis patients: A cohort study from NHANES 1999-2014.

Patients with Rheumatoid arthritis (RA) are prone to malnutrition. However, it is rare studies assessing the relationship between malnutrition and all-cause mortality in patients with RA. To investigate the relationship between malnutrition and all-cause mortality in patients with RA in a large national sample cohort. We analyzed data on 1,976 adults ≥ 18 years of age during National Health and Nutrition Examination Survey (NHANES) 1999-2014. We chose the Controlled Nutritional Status Score (CONUT) and the Nutritional Risk Index (NRI) to assess the nutritional status of patients with RA. The Kaplan-Meier (KM) survival curves Cox proportional hazards regression models were used to analyze the associations between malnutrition and all-cause mortality. Of the 1,976 patients with RA (57.38 ± 0.40 years, female 59.9%, non-Hispanic white 69.9%), the prevalence of malnutrition was 18.8% by used the CONUT and 26.6% by used the NRI. The KM survival curves showed that malnutrition was associated with a higher incidence of all-cause mortality during the 10-year follow-up period (log-rank test, P < 0.001). In the fully corrected model, the adjusting hazard ratio (aHR) for all-cause mortality in patients with moderate to severe malnutrition with CONUT and NRI were 5.63 (95% CI, 2.55-12.45; P < 0.001) and 2.56 (95% CI, 1.81-3.62; P < 0.001), respectively, compared with patients without malnutrition. Malnutrition is very prevalent in patients with RA, approximately 18.8% (CONUT) to 26.6% (NRI). Malnutrition is strongly associated with an increased risk of all-cause mortality. These findings underscore the importance of attention and intervention in the nutritional status of patients with RA. Further clinical trials are needed to prospectively assess the effect of nutritional interventions on the prognosis of patients with RA.

Corneal complications of rheumatoid arthritis.

Rheumatoid arthritis (RA) is an autoimmune disease that primarily affects the joints. Extra-articular manifestations (EAMs) are common and may affect up to 40.6% of patients. Ocular EAM can occur in 39% of the patients. The cornea is involved by different pathogenic mechanisms and corneal disease varies from mild symptoms to severe corneal ulceration and melting with visual loss. Severe corneal involvement is associated with increased mortality in RA patients. We aimed to review the prevalence, mechanisms, management and overall impact of corneal involvement in RA patients. Corneal involvement is frequent among RA patients. With the wider use of systemic immunosuppression, in particular the disease-modifying antirheumatic drugs (DMARDs), and with improvement of surgical techniques, spontaneous and surgery-related corneal ulceration and melting is becoming less common. However, RA patients are still at risk and should be carefully managed. RA-related corneal complications are associated with a decreased quality of life and poor ocular and systemic prognosis. Prompt recognition and a multidisciplinary approach involving topical ophthalmic management and systemic immunosuppression are the key factors to maintain ocular integrity and avoid a lethal outcome.

Biologic DMARDs and targeted synthetic DMARDs and the risk of all-cause mortality in rheumatoid arthritis: A systematic review and meta-analysis.

Background:The aim of this study was to perform a meta-analysis to compare the risk of all-cause mortality between biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) and non-b/tsDMARDs involving patients with rheumatoid arthritis (RA).Methods:We performed a systematic review of articles published up to August 2021 using electronic databases. We included studies that reported all-cause mortality in RA patients and compared b/tsDMARDs and non-b/tsDMARDs.Results:We included a total of 77 studies involving 64,428 patients. These comprised 44,227 patients treated with b/tsDMARDs and 20,201 treated with non-b/tsDMARDs. The occurrence of all-cause mortality was the primary outcome. The risk of all-cause mortality between the 2 treatments was not significantly different (relative risk = 1.08; 95% confidence interval = 0.98–1.19). However, subgroup analyses showed significant increase in risks of mortality in anti-TNFs users with RA compared with non-b/tsDMARDs (relative risk = 1.47, 95% confidence interval = 1.02–2.12). No significant differences were found after subgroup analyses based on other molecules involved and study duration.Conclusion:In comparison with non-b/tsDMARDs, our results suggest that antitumor necrosis factor therapy is associated with observed increased risks of mortality and further investigation is needed.

Analysis of risk factors of mortality in rheumatoid arthritis patients with interstitial lung disease: a nationwide, population-based cohort study in Taiwan

ObjectiveTo examine the risk and risk factors of mortality in patients with rheumatoid arthritis (RA) with interstitial lung disease (ILD).MethodsUsing the 1997–2013 Taiwanese National Health Insurance Research Database, we identified...

Long-Term Effect of Non-Selective Beta-Blockers in Patients With Rheumatoid Arthritis After Myocardial Infarction-A Nationwide Cohort Study.

Objectives: Rheumatoid arthritis (RA) is an independent nontraditional risk factor for incidence of myocardial infarction (MI) and post-MI outcome is impaired in the RA population. Use of beta-blockers improves the long-term survival after MI in the general population while the protective effect of beta-blockers in RA patients is not clear. We investigate the impact of beta-blockers on the long-term outcome of MI among RA patients.Methods: We identified RA subjects from the registries for catastrophic illness and myocardial infarction from 2003 to 2013. The enrolled subjects were divided into three groups according to the prescription of beta-blockers (non-user, non-selective, and β1-selective beta-blockers). The primary endpoint was all-cause mortality. We adjusted clinical variables and utilized propensity scores to balance confounding bias. Cox proportional hazards regression models were used to estimate the incidence of mortality in different groups.Results: A total of 1,292 RA patients with myocardial infarction were enrolled, where 424 (32.8%), 281 (21.7%), and 587 (45.5%) subjects used non-user, non-selective, and β1-selective beta-blockers, respectively. Use of beta-blockers was associated with lower risk of all-cause mortality after adjustment with comorbidities, medications (adjusted hazard ratio [HR] 0.871; 95% confidence interval [CI] 0.727–0.978), and propensity score (HR 0.882; 95% CI 0.724–0.982). Compared with β1-selective beta-blockers, treatment with non-selective beta-blockers (HR 0.856; 95% CI 0.702–0.984) was significantly related to lower risk of mortality. The protective effect of non-selective beta-blockers remained in different subgroups including sex and different anti-inflammatory drugs.Conclusion: Use of beta-blockers improved prognosis in post-MI patients with RA. Treatment with non-selective beta-blockers was significantly associated with reduced risk of mortality in RA patients after MI rather than β1-selective beta-blockers.

Alcohol consumption and the risk of mortality and myocardial infarction in patients with rheumatoid arthritis.

Many studies have found that moderate alcohol consumption is associated with lower risks of mortality and myocardial infarction (MI). Our aim was to examine the potential effects of alcohol on all-cause mortality and MI in rheumatoid arthritis (RA), a risk factor condition. A cohort study (1995-2017) was conducted using medical records of RA patients from The Health Improvement Network in the United Kingdom (UK). Alcohol exposure was divided into non-drinkers, mild (1-7 UK units/week), moderate (8-14 UK units/week), moderate-high (15-21 UK units/week), and high (>21 UK units/week) consumption levels. We calculated hazard ratios (HRs) for the relation of alcohol consumption to all-cause mortality and MI, adjusting for covariates. Of 30,320 RA patients, 5,994 deaths and 1,098 MI cases occurred over 236,188 person-years. Mild-to-moderate alcohol use was associated with lower all-cause mortality in RA patients, including those taking methotrexate. The multivariable HRs (95% CI) for mortality by alcohol use category were non-drinkers 1.0, mild 0.80 (0.75-0.85), moderate 0.74 (0.67-0.82), moderate-high 0.84 (0.72-0.98), and high 0.99 (0.86-1.15). Mild, moderate-high, and high levels of alcohol use were associated with lower risk of MI among RA patients. The HRs MI risk by alcohol use category were non-drinkers 1.0, mild 0.81 (0.70-0.94), moderate 0.84 (0.68-1.04), moderate-high 0.51 (0.35-0.74), and high 0.59 (0.42-0.84). These findings suggest that mild-to-moderate alcohol use is associated with a lower mortality risk and overall alcohol use is associated with a lower MI risk in RA patients, similar to the general population.

Statin use and mortality in rheumatoid arthritis: an incident user cohort study.

BACKGROUND: Patients with rheumatoid arthritis (RA) have higher rates of mortality attributed to the inflammatory nature and the associated burden of cardiovascular complications. Previous research indicates that treatment with statin therapy may play a role in reducing the mortality rate of RA patients, but similar evidence in U.S. patients is lacking. OBJECTIVE: To assess the association between statin use and overall mortality among RA patients in the United States. METHODS: A population-based study of RA patients with incident statin use was conducted. Patients aged ≥ 18 years with a diagnosis of RA between January 2007 and December 2015 were included and reviewed for the use of statin medication. Time stratified propensity score matching was used to adequately balance the comparison groups. Logistic regression and Cox proportional hazard models were used to estimate the association. RESULTS: 19,614 people fulfilled the inclusion criteria for the study out of which 2,089 were statin users. There were 1,883 statin users that were matched to 1,883 statin nonusers. Baseline characteristics were well balanced across the 2 groups after matching. The hazards ratio for all-cause mortality in patients with RA for statin users was 0.72 (95% CI = 0.56-0.91; P = 0.008) compared with statin nonusers. CONCLUSIONS: Compared with no use of statins, current statin use is associated with 28% lower risk of mortality in RA patients. Decision makers and providers should consider and support integration of these results into the current clinical guidelines for delivering quality health care to RA patients. DISCLOSURES: No outside funding supported this study. The authors received no financial support for the research, authorship, and/or publication of this article. The authors have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript.

Trends in mortality, co-morbidity and treatment after acute myocardial infarction in patients with rheumatoid arthritis 1998-2013.

Rheumatoid arthritis may influence the outcome after an acute myocardial infarction. We aimed to compare trends in one-year mortality, co-morbidities and treatments after a first acute myocardial infarction in patients with rheumatoid arthritis versus non-rheumatoid arthritis patients during 1998-2013. Furthermore, we wanted to identify characteristics associated with mortality. Data for 245,377 patients with a first acute myocardial infarction were drawn from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions for 1998-2013. In total, 4268 patients were diagnosed with rheumatoid arthritis. Kaplan-Meier analysis was used to study mortality trends over time and multivariable Cox regression analysis was used to identify variables associated with mortality. The one-year mortality in rheumatoid arthritis patients was initially lower compared to non-rheumatoid arthritis patients (14.7% versus 19.7%) but thereafter increased above that in non-rheumatoid arthritis patients (17.1% versus 13.5%). In rheumatoid arthritis patients the mean age at admission and the prevalence of atrial fibrillation increased over time. Congestive heart failure decreased more in non-rheumatoid arthritis than in rheumatoid arthritis patients. Congestive heart failure, atrial fibrillation, kidney failure, rheumatoid arthritis, prior diabetes mellitus and hypertension were associated with significantly higher one-year mortality during the study period 1998-2013. The decrease in one-year mortality after acute myocardial infarction in non-rheumatoid arthritis patients was not applicable to rheumatoid arthritis patients. This could partly be explained by an increased age at acute myocardial infarction onset and unfavourable trends with increased atrial fibrillation and congestive heart failure in rheumatoid arthritis. Rheumatoid arthritis per se was associated with a significantly worse prognosis.

OP0039 HOSPITALIZATION AND MORTALITY OUTCOMES IN RHEUMATOID ARTHRITIS PATIENTS WITH LUNG DISEASE

Background:Pulmonary manifestations such as interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) are frequent extra-articular features that carry a poor prognosis in rheumatoid arthritis (RA). Prior studies have demonstrated that respiratory-related mortality is the most overrepresented cause of death in RA.Objectives:To assess the risk of all-cause and respiratory-related hospitalization and mortality in RA patients with comorbid lung disease (LD) in comparison to those without and the differential risks associated with DMARD treatments.Methods:Eligible RA patients included those enrolled in the Forward Databank with ≥1 year observation after 2000 and had initiated a DMARD. Forward is a large longitudinal rheumatic disease registry in the US. RA patients’ diagnoses were rheumatologist-confirmed, and every 6 months participants completed comprehensive questionnaires regarding symptoms, disease outcomes, medications, and clinical events. LD was defined as one of the following: emphysema, asthma, bronchitis, COPD, pleural effusion, fibrosis of the lung, “RA lung“, or ILD (England 2019). DMARDs were categorized hierarchically into four groups: csDMARDs, TNFi and NTNFi (bDMARDs), and tsDMARDs. Patients were followed from DMARD initiation until event (death and/or hospitalization) or end of follow-up, whatever came first. Events were validated using medical records and the US National Death Index. Respiratory hospitalizations and deaths were identified with ICD9 (460-519). Events were analyzed using incidence rates (IR) and Cox regression models. Models were adjusted for LD, DMARDs, age, sex, education, HAQ disability, Rheumatic Disease comorbidity index, smoking, pain, glucocorticoids, year of entry, prior bDMARDs and csDMARDs counts and MRC breath scale.Results:Of the 21,525 eligible RA patients, 13.8% had LD at the time of DMARD initiation. Patients had 59 years old in both groups and 15% were male for LD+ vs 21% for LD-. Patients with LD+ showed worse disease outcomes (HAQ: 1.3 (0.7) vs 1.0 (0.7)) and comorbidities (2.9 (1.9) vs 1.5 (1.4)) overall and for all treatment groups, especially for NTNFi and tsDMARDi. The overall IR of any all-cause or respiratory-related events were higher in LD+ than LD- RA patients and across any DMARD treatments, with NTNFi having higher IR (Figure). In survival analyses, LD+ was associated with an increased risk for all-cause hospitalizations/deaths (HR 1.3; 95% CI 1.1-1.4) and a 3.95-fold increased risk of respiratory-related events (HR 4.0; 3.2-4.9) (Table). These risks did not differ significantly across DMARD treatment groups. Increased age, HAQ disability, comorbidities, glucocorticoids, prior bDMARDs and worse MRC breath scales were associated with an increased risk in both outcomes and smoking in respiratory-specific events.Conclusion:An increased risk of hospitalizations and/or deaths was demonstrated for RA patients with lung disease, most notably a 4-fold increased risk for respiratory-related events. No differences were found between incident DMARD groups. Additional studies accounting for channeling of treatments by baseline health status are needed.