Isomäki H

Mortality in rheumatoid arthritis

Patients with rheumatoid arthritis (RA) have a substantially reduced life expectancy. The standardized mortality ratio in different studies has ranged from 1.13 to 2.98. This mainly applies to rheumatoid factor (RF)-positive cases, although there is a subgroup of RF-negative cases with an adverse long-term prognosis. Clinically based studies probably overestimate the true shortening of life span and population-based studies may underestimate it. Excess mortality from infection and from renal disease likely reflects the presence of severe disease, whereas most of the added mortality from gastrointestinal causes is treatment related. The reasons for the surplus of mortality from cardiovascular causes are not fully known. RF may have a direct role, and preillness factors such as smoking may predipose patients to RA and also render them susceptible to cardiovascular diseases. The excess mortality associated with RA is appreciably higher than is apparent from the cases in which RA is regarded as an underlying cause of death. The effect of treatment on mortality remains largely unknown.

Weight-bearing Physical Activity, Calcium Intake, Systemic Glucocorticoids, Chronic Inflammation, and Body Constitution as Determinants of Lumbar and Femoral Bone Mineral in Juvenile Chronic Arthritis

The associations between the lumbar and femoral bone mineral and several body constitutional, lifestyle, and disease related variables were studied in 111 children with juvenile chronic arthritis (JCA) by factor and multiple linear regression analyses. In addition to the measurement of bone mineral density (BMD), bone width and bone mineral volumetric density (BMDvol) were determined by dual-x-ray absorptiometry (DXA). Factor analysis of 13 explanatory variables yielded six non-correlating factors, named as body size, physical activity, calcium intake, glucocorticoids, disease duration, and disease activity. These six factors were used as new variables to explain BMD, BMDvol, and bone width by multiple linear regression analyses. These showed body size, physical activity, and calcium intake as significant positive and disease activity and glucocorticoids as significant negative determinants of BMD in JCA. The analyses revealed also considerable differences in the relationships between factors and BM Dvol or bone width.

Mortality from cancer in patients with rheumatoid arthritis.

Data in nationwide Finnish registers were used to study the relationship between rheumatoid arthritis (RA) and site-specific cancers as a cause of death. The study included in all 1,666 subjects who had died in 1989 and who were entitled, under the nationwide sickness insurance scheme, to specially reimbursed medication because of RA. There were 277 deaths from malignancies. The proportion of such deaths in relation to all deaths declined with the duration of RA (p < 0.05). There was an excess of hematopoietic malignancies, particularly in males (p < 0.05). Deaths due to these malignancies, in relation to all cancer deaths, accumulated in long-lasting RA (p < 0.05). This suggests that hematopoietic malignancies arise as a complication of either RA or its treatment and to some degree argues against the notion of a shared etiological agent for these diseases.

Atlantoaxial laxity in rheumatoid arthritis

We found that 14 of 162 rheumatoid arthritis patients with chronic occipitocervical pain had anterior atlantoaxial instability in the absence of any corresponding radiographic changes in the joint cartilage or subchondral bone. Our findings suggest that ligamentous instability is a prerequisite for this type of change. At the time of the detection of the instability, the median duration of disease was 12 (6-28) years. Rheumatoid occipitocervical pain may be initially caused by facet-joint arthritis or inflammation in the ligaments, and at a later stage also by irritation of the C2 nerve roots.

Age specific mortality in Finnish women with chronic inflammatory joint diseases during 1977–93

It has been known for 40 years ago that rheumatoid arthritis (RA) is associated with reduced life expectancy,1 a finding confirmed by numerous studies.2-4 Most RA mortality studies compare observed deaths in patient cohorts with expected from reference populations or case controls. Because of differences in composition of study series, length of follow up, and means to express the findings, the figures are not fully comparable. Crude death rates, however, have not improved.3 4 In 1953, Cobb et al 1 reported a standardised mortality ratio (SMR) of 1.3; in the recent study by Wolfe et a l5the SMR was 2.3. In this study we have made use of the Finnish nationwide sickness insurance statistics to follow up age specific mortality in women with chronic inflammatory joint diseases during a 17 year period. Since 1966, the Sickness Insurance Act has provided for the prescription of drugs (glucocorticoids, non-steroidal anti-inflammatory drugs, and disease modifying antirheumatic drugs) free of charge, usually lifelong, for chronic inflammatory joint diseases (since 1987, 90% of the costs have been reimbursed). The scheme covers the entire population, and almost all patients with RA make use of it.6 Eligibility requires …