Cause and age at death in a prospective study of 100 patients with rheumatoid arthritis. Ann Rheum Dis

SUMMARY A series of 100 patients with rheumatoid arthritis (RA), first seen in the early months of their disease, have now been followed up for 18 years, and 43 have died. Rheumatoid disease directly caused death in 9, and the disease or its treatment contributed to death in 7. These 16 patients were younger at onset and younger at death than the 27 in whom death was unrelated to RA. Of clinical features noted 1 year after the onset of RA a worse ARA grading and a worse functional capacity were already evident in those 16 patients. Conversely, the 57 still surviving had a better ARA grading and a better functional capacity after 1 year than those who died. The survivors were also significantly younger than the rest at the onset of RA. The death rate throughout the follow-up period was higher in the patients graded as 'classical ' than those graded as 'definite ' RA after 1 year of disease. The degree to which rheumatoid arthritis (RA) influences life expectancy and the causes of death is the subject of a number of reports. Some16 indicate that patients with RA have a reduced life expectancy as a result of the disease. Others,7 8 analysing the causes of death, distinguish between deaths attributable in some way to RA and deaths unrelated to it. Thus, Eulderink7 found that among 111 deaths approximately 1 in 5 were related to the arthritis and 1 in 8 to its treatment. Similarly, Constable et al.8 found among 100 deaths proportion