Background/Purpose: Life span of patients with rheumatoid arthritis (RA) is reduced by 3-10 years compared to non-RA population. Only recent reports indicate improvements in survival outcomes in RA in a few countries. The QUEST-RA study indicated that RA continues to be an active and severe disease especially in countries with lower gross domestic product (ARD 2009;68:1666-7). Therefore, it is of interest to compare survival outcomes of patient with RA in different countries. Our objective was to study long-term survival of patients with early RA in Vilnius (VIL), Lithuania, and Jyväskylä (JYV), Finland, and predictors of vital status as well as comparison to the population.

Methods: A cohort of 191 patients with early RA (disease duration <4 years) was established in VIL in 1998 – 2003. A comparison cohort was drawn from the JYV RA database that includes all incident and prevalent patients with RA since 1982. To each VIL patient, a control subject was identified in JYV, matched for gender, year of birth, starting year of arthritis, and RF status (negative, positive). Vital status of the patients was acquired from the central statistics office in each country. Regression analyses for mortality included nation, baseline disease activity(DAS28_esr3), patient self-report of function(HAQ), early continuous use of DMARDs and systemic steroids(SS), presence of a life threatening disease(LTD), smoking, and a type of work (white vs blue collar) as a proxy of wealth. Patients were followed until December 2012 or death, which ever happened first. Standard Mortality Ratio (SMR) was calculated.

Results: A total of 186 patients and controls (age at diagnosis 52 years, 78%F, 85% RF+) were included in analyses. Over a median (IQR) follow-up of 13 (11, 15) years, 55 and 32 patients died in VIL and JYV, respectively, including 16(40%) and 11(28%) of men (p=0.24) and 39(27%) and 21(15%) of women (p=0.009) [HR=1.83 (95% CI: 1.18 to 2.83), p<0.001] . In multivariate analysis, age and country were the only independently significant variables for mortality. SMR (95%CI) was similar to that of the population in each country (VIL: 1.3, 1.0 to 1.7; JYV: 1.4, 1.0 to 1.9).

Conclusion: In this analysis of patients with early RA over a median of 13 years, higher mortality was seen in VIL compared to JYV patients but SMR was similar to the general population in each country indicating improved outcomes of RA in these countries.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-in-early-rheumatoid-arthritis-comparing-lithuania-and-finland-a-13-year-follow-up/