Survival and Mortality in RA: time to move away from “one-size fits all”? Save

Patients with RA are known to have a higher mortality risk than the general population.

In abstract 0246, Crowson et al propose a retrospective population-based study stratifying RA patients according to their comorbidities.

Amongst 1600+ patients with prevalent RA, almost all had a least 1 comorbidity (94%), while almost 2 out 3 (59%) had at least 5 comorbidities.

Interestingly, the authors were able to identify 4 clusters associated with distinct trajectories and standardized mortality ratios. 1/3 of the patients constituted Cluster 1; patients were likely to be younger, less likely to smoke and with fewer comorbidities than the other groups. This cluster had no increased mortality based on US lifetables. On the opposite, Cluster 4 (1/10 patients) included older patients with 6+ comorbidities, more likely to have smoked and had the worst survival. Other clusters included younger patients with high number of comorbidities (Cluster 2) or older patients with comorbidities comparable to general population (Cluster 3). They both had a poorer survival than general population although this was less pronounced in Cluster 3.

This work highlights differences in survival outcomes in RA patients based on comorbidities, suggesting that the rise in mortality risk does not apply to the entire RA population but could be restricted to an older group with higher number of comorbidities.

More studies are warranted to understand these patterns considering RA disease activity and treatments.