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18-11-2021 | Rheumatology | News | Article

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Excess mortality gap closing, but not for all rheumatic diseases

Laura Cowen

medwireNews: Individuals with rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA) have almost comparable survival rates to those of the general population, Greek study findings indicate.

However, individuals with systemic lupus erythematosus (SLE) or systemic sclerosis (SSc) have a two- to fourfold increased risk for death, report Petros Sfikakis (National and Kapodistrian University of Athens) and co-authors in RMD Open.

“Given that effective therapeutic options and treat-to-target strategies, including control of comorbidities, can explain the improved survival observed in rheumatoid arthritis and the spondylarthritides during the calendar years 2015–2019, similar approaches should be implemented in all systemic rheumatic diseases,” they write.

The population-based study drew on anonymized social security data for 11,186,586 Greek citizens, including all individuals with RA (n=42,735), AS (n=9707), PsA (n=13,779), SLE (10,440), or SSc (n=2277) who were receiving prescribed treatment for their condition between 2015 and 2019.

After pairing each patient with five age- and sex-matched controls from the general population, the researchers found that the crude mortality rate was lower in the people with RA relative to their controls, at 19.07 versus 24.16 deaths per 1000 person–years.

There was a similar pattern for AS (4.57 vs 6.12 per 1000 person–years) and PsA (8.22 vs 10.33 per 1000 person–years), but not for those with SLE and SSc.

For SLE, the mortality rate was 15.00 per 1000 patient–years compared with 9.20 per 1000 person–years, while for SSc, which had the highest mortality overall, the corresponding rates were 33.70 versus 12.45 per 1000 person–years.

The researchers also observed that the risk for all-cause death changed with time. During the first 3 years of follow-up, the hazard ratio (HR) for death was a significant 0.63 among people with RA relative to controls, but this increased to a significant 1.13 during years 3 to 5.

Similarly, the HRs for death were a significant 0.62 and 0.68 in people with AS and PsA, respectively, versus controls during the first 3 years, increasing to a nonsignificant 1.01 and 1.06, respectively, in years 3 to 5.

Conversely, the mortality risks were significantly higher for people with SLE and SSc compared with controls during both periods, and increased with time from 1.52 to 1.98 and from 2.27 to 4.24, respectively.

This shows that “disease duration seems to negatively affect mortality in all systemic rheumatic diseases, leading to slightly increased mortality risk for RA and to abolishment of reduced mortality for [spondyloarthritis], 3 years after disease diagnosis,” Sfikakis et al remark.

Finally, the investigators found that male sex and younger age (<50 years) are adverse prognostic factors in SLE and SSc but not in other rheumatic diseases, suggesting “that these patients need closer follow-up and more effective treatments.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

RMD Open 2021; 7: e001694

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