期刊
RHEUMATOLOGY
卷 50, 期 1, 页码 101-109出版社
OXFORD UNIV PRESS
DOI: 10.1093/rheumatology/keq232
关键词
Rheumatoid arthritis; Mortality; US veterans; Men; MTX; Glucocorticoids
类别
资金
- Veterans Health Administration (VHA)
- Abbott Laboratories
- Bristol-Myers Squibb
- National Institute of Arthritis and Musculoskeletal and Skin Diseases [K23 AR050004, R03 AR054539]
- VHA (VA Merit)
- VA HSR&D Career Development Award [CDP 09-388]
- NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES [K23AR050004, R03AR054539] Funding Source: NIH RePORTER
Methods. Men with RA were enrolled and followed until death or censoring. Vital status was ascertained through systematic record review and standardized mortality ratios (SMRs) were calculated using US life tables for men. Multivariate Cox proportional hazards regression was used to examine the independent associations of patient factors including socio-demographics, comorbidity, measures of RA disease activity/severity and medication use with mortality. Measures of RA disease activity and medications were examined as time-varying factors. Results. A total of 138 deaths were observed during 2314 patient-years of follow-up (n = 1015 patients), corresponding to a crude morality rate of 5.9 deaths per 100 patient-years (95% CI 5.0, 7.0) and an SMR of 2.1 (95% CI 1.8, 2.5). After multivariate adjustment, factors independently associated with higher mortality risk in men with RA included older age, Caucasian race, low body weight, an increased frequency of rheumatology visits, higher ESR and RF concentrations, increased DAS28, subcutaneous nodules and prednisone use. In contrast, MTX use [hazard ratio (HR) 0.63; 95% CI 0.42, 0.96] was associated with similar to 40% lower mortality risk. Conclusion. Mortality rates among US male veterans with RA are more than twice those of age-matched men in the general population. These results suggest that optimizing disease control, particularly with regimens that include MTX and minimize glucocorticoid exposure, could improve long-term survival in this population.
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