Seropositivity Increases Mortality Rates in Rheumatoid Arthritis Save

It has been long known that rheumatoid arthritis is associated with an increased mortality rate, especially in seropositive patients and those with extraarticular manifestations. With the advent of new RA associated autoantibodies, Ajegenova et al studied the effects of different autoantibodies on mortality and cause of mortality.

Three RA cohorts and 2331 patients comprised the population under study.  This included patients from the Better Anti-Rheumatic Farmaco-Therapy cohort (BARFOT) (n=805), Norfolk Arthritis Register (NOAR) (n=678) and Leiden Early Arthritis Clinic cohort (EAC) (n=848) were studied.

Patients were assayed for the presence of anticitrullinated protein antibodies (ACPA), rheumatoid factor (RF) and anticarbamylated protein (anti-CarP) antibodies. 

With 26,300 person-years of observation (over 10years of follow-up), death was noted in 29% of BARFOT patients, 30% of NOAR and 18% of EAC patients.  The mortality rates of 24.9, 21.0 and 20.8 per 1000 person-years, respectively,

The HR for all-cause mortality (95% CI) was 1.48 (1.22 to 1.79) for ACPA, 1.47 (1.22 to 1.78) for RF and 1.33 (1.11 to 1.60) for anti-CarP.

Interestingly, if patients were stratified to cause of death, ACPA positivity associated with increased cardiovascular death, HR 1.52 (1.04 to 2.21), and RF with increased neoplasm-related death, HR 1.64 (1.02 to 2.62), and respiratory disease-related death, HR 1.71 (1.01 to 2.88).

Why ACPA associates with increased cardiovascular death and RF with death related to neoplasm and respiratory disease is unknown and subject to further study..