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Mortality risk associated with rheumatoid arthritis in a prospective cohort of older women: results from the Iowa Women’s Health Study
  1. T R Mikuls1,
  2. K G Saag1,
  3. L A Criswell2,
  4. L A Merlino3,
  5. R A Kaslow4,
  6. B J Shelton4,
  7. J R Cerhan5
  1. 1Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, USA
  2. 2Rosalind Russell Medical Research Center for Arthritis, University of California, San Francisco, Department of Medicine, USA
  3. 3College of Public Health, University of Iowa, USA
  4. 4School of Public Health, University of Alabama at Birmingham, USA
  5. 5Department of Health Sciences Research, Mayo Clinic, USA
  1. Correspondence to:
    Professor T R Mikuls, Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, MEB 625, 1530 3rd Avenue South, Birmingham, AL, USA 35294-3296;


Objective: To determine whether rheumatoid arthritis (RA) is associated with excess mortality among older women.

Methods: RA associated mortality was examined in a prospective cohort study that was started in 1986, and included 31 336 women aged 55–69 years without a history of RA at baseline. Up to 1997, 158 cases of RA were identified and validated against medical records. The relative risk (RR) and 95% confidence interval (CI) were calculated as measures of association between RA onset and subsequent mortality (overall and cause-specific) using Cox proportional hazards regression.

Results: Compared with non-cases, women developing RA during follow up had a significantly increased mortality risk (RR=1.52; 95% CI 1.05 to 2.20). Mortality was higher among rheumatoid factor (RF) positive cases (RR=1.90; 95% CI 1.24 to 2.92) than among RF negative cases (RR=1.00; 95% CI 0.45 to 1.99). There were trends towards increased proportions of RA related deaths from infection (RR=3.61; 95% CI 0.89–14.69) and circulatory disease (RR=1.46; 95% CI 0.76 to 2.81) but not malignancy (RR=0.97; 95% CI 0.46 to 2.04).

Conclusions: RA was associated with significantly increased mortality in a cohort of older women, and the association appeared to be restricted to those with RF positive disease.

  • rheumatoid arthritis
  • mortality
  • elderly onset
  • rheumatoid factor
  • ACR, American College of Rheumatology
  • CI, confidence interval
  • IWHS, Iowa Women’s Health Study
  • RA, rheumatoid arthritis
  • RF, rheumatoid factor
  • RR, relative risk
  • SMR, standardised mortality rate
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