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Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis

Turesson, Carl LU ; O'Fallon, WM; Crowson, CS; Gabriel, SE and Matteson, EL (2002) In Journal of Rheumatology 29(1). p.62-67
Abstract
Objective. To investigate the occurrence of extraarticular manifestations (ExRA) in it well defined community based cohort of patients with rheumatoid arthritis (RA), and to examine their effect on mortality, Methods. Using the resources of the Rochester Epidemiology Project. a retrospective medical record review was conducted of a cohort of 424 cases of RA in Olmsted County, MN, USA, diagnosed during the period 1955-1985. These cases had been classified using the American College of Rheumatology 1987 criteria for RA. Patients were followed 1955-1998 (median followup 14.8 yrs: range 0.2-42.8 yrs), and incident ExRA manifestations were recorded according to predefined criteria. Data on comorbidities were extracted using the definitions of... (More)
Objective. To investigate the occurrence of extraarticular manifestations (ExRA) in it well defined community based cohort of patients with rheumatoid arthritis (RA), and to examine their effect on mortality, Methods. Using the resources of the Rochester Epidemiology Project. a retrospective medical record review was conducted of a cohort of 424 cases of RA in Olmsted County, MN, USA, diagnosed during the period 1955-1985. These cases had been classified using the American College of Rheumatology 1987 criteria for RA. Patients were followed 1955-1998 (median followup 14.8 yrs: range 0.2-42.8 yrs), and incident ExRA manifestations were recorded according to predefined criteria. Data on comorbidities were extracted using the definitions of the Charlson comorbidity index. Survival was compared to the general population using Kaplan-Meier estimates. Results. ExRA occurred in 169 patients. corresponding to an incidence rate of 3.67/100 person-yrs. Compared to the general population, survival among patients with RA was decreased. Survival anion,,, patients with ExRA was markedly decreased compared to the general population and to patients without ExRA (p < 0.001). A particularly poor prognosis was noted in a subgroup of 63 patients (incidence rate 1.04/100 person-yrs) who fulfilled predefined criteria for severe ExRA (i.e., vasculitis, pericarditis, pleuritis, and/or Felty's syndrome). For RA patients who did not fulfill these criteria, there was no significant increase of mortality (p = 0.09). In a multivariate model of mortality, including age, sex, and the presence of known comorbidities, the presence of one or more of these ExRA was the strongest predictor of mortality. Conclusion. In this first community based study of extraarticular manifestations in RA, virtually all the excess mortality occurred in a subgroup of patients with severe extraarticular disease, suggesting that extraarticular disease is the major predictor of mortality in patients with RA. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
rheumatoid arthritis, extraarticular manifestations, mortality, epidemiology
in
Journal of Rheumatology
volume
29
issue
1
pages
62 - 67
publisher
J Rheumatol Publ Co
external identifiers
  • pmid:11824973
  • wos:000173146600011
  • scopus:0036138495
ISSN
0315-162X
language
English
LU publication?
yes
id
dc24e26b-a8ff-4366-9bae-95f4ab0bbafb (old id 345839)
date added to LUP
2007-11-16 13:45:21
date last changed
2017-10-22 03:42:36
@article{dc24e26b-a8ff-4366-9bae-95f4ab0bbafb,
  abstract     = {Objective. To investigate the occurrence of extraarticular manifestations (ExRA) in it well defined community based cohort of patients with rheumatoid arthritis (RA), and to examine their effect on mortality, Methods. Using the resources of the Rochester Epidemiology Project. a retrospective medical record review was conducted of a cohort of 424 cases of RA in Olmsted County, MN, USA, diagnosed during the period 1955-1985. These cases had been classified using the American College of Rheumatology 1987 criteria for RA. Patients were followed 1955-1998 (median followup 14.8 yrs: range 0.2-42.8 yrs), and incident ExRA manifestations were recorded according to predefined criteria. Data on comorbidities were extracted using the definitions of the Charlson comorbidity index. Survival was compared to the general population using Kaplan-Meier estimates. Results. ExRA occurred in 169 patients. corresponding to an incidence rate of 3.67/100 person-yrs. Compared to the general population, survival among patients with RA was decreased. Survival anion,,, patients with ExRA was markedly decreased compared to the general population and to patients without ExRA (p &lt; 0.001). A particularly poor prognosis was noted in a subgroup of 63 patients (incidence rate 1.04/100 person-yrs) who fulfilled predefined criteria for severe ExRA (i.e., vasculitis, pericarditis, pleuritis, and/or Felty's syndrome). For RA patients who did not fulfill these criteria, there was no significant increase of mortality (p = 0.09). In a multivariate model of mortality, including age, sex, and the presence of known comorbidities, the presence of one or more of these ExRA was the strongest predictor of mortality. Conclusion. In this first community based study of extraarticular manifestations in RA, virtually all the excess mortality occurred in a subgroup of patients with severe extraarticular disease, suggesting that extraarticular disease is the major predictor of mortality in patients with RA.},
  author       = {Turesson, Carl and O'Fallon, WM and Crowson, CS and Gabriel, SE and Matteson, EL},
  issn         = {0315-162X},
  keyword      = {rheumatoid arthritis,extraarticular manifestations,mortality,epidemiology},
  language     = {eng},
  number       = {1},
  pages        = {62--67},
  publisher    = {J Rheumatol Publ Co},
  series       = {Journal of Rheumatology},
  title        = {Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis},
  volume       = {29},
  year         = {2002},
}