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Mortality following new-onset Rheumatoid Arthritis: has modern Rheumatology had an impact?
  1. Marie Holmqvist1,
  2. Lotta Ljung2,
  3. Johan Askling1
  1. 1 Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
  2. 2 Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
  1. Correspondence to Dr Marie Holmqvist, Department of Medicine, Solna Clinical Epidemiology Unit, Karolinska Institute, T2 SE-171 76 Stockholm, Sweden; marie.holmqvist{at}


Objective To investigate if, and when, patients diagnosed with rheumatoid arthritis (RA) in recent years are at increased risk of death.

Methods Using an extensive register linkage, we designed a population-based nationwide cohort study in Sweden. Patients with new-onset RA from the Swedish Rheumatology Quality Register, and individually matched comparators from the general population were followed with respect to death, as captured by the total population register.

Results 17 512 patients with new-onset RA between 1 January 1997 and 31 December 2014, and 78 847 matched general population comparator subjects were followed from RA diagnosis until death, emigration or 31 December 2015. There was a steady decrease in absolute mortality rates over calendar time, both in the RA cohort and in the general population. Although the relative risk of death in the RA cohort was not increased (HR=1.01, 95% CI 0.96 to 1.06), an excess mortality in the RA cohort was present 5 years after RA diagnosis (HR after 10 years since RA diagnosis=1.43 (95% CI 1.28 to 1.59)), across all calendar periods of RA diagnosis. Taking RA disease duration into account, there was no clear trend towards lower excess mortality for patients diagnosed more recently.

Conclusions Despite decreasing mortality rates, RA continues to be linked to an increased risk of death. Thus, despite advancements in RA management during recent years, increased efforts to prevent disease progression and comorbidity, from disease onset, are needed.

  • early rheumatoid arthritis
  • outcomes research
  • arthritis

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  • Handling editor Tore K Kvien

  • Contributors Study concept and design: JA, MH, LL. Acquisition of data: MH, JA. Statistical analysis: MH, LL. Analysis and interpretation of data: MH, LL, JA. Drafting of manuscript: MH, LL. Critical revision of manuscript and final approval given: MH, LL, JA. Obtained funding: JA. Study supervision: JA.

  • Funding This work was supported by the Swedish Research Council, the Swedish Foundation for Strategic Research, Stockholm County Council (ALF), the Heart Lung Foundation, Karolinska Institutet (Strategic Research Area Epidemiology). Funders had no impact on the design or interpretation of the study or its results.

  • Competing interests LL has received personal fees for educational activities by Pfizer and Bristol Myers Squibb and has participated in advisory board arranged by Pfizer. JA has or has had research agreements with Abbvie, BMS, MSD, Pfizer, Roche, Astra-Zeneca, Lilly and UCB, mainly in the context of safety monitoring of biologics via ARTIS/Swedish Biologics Register. Karolinska Institutet has received remuneration for JA participating in ad boards arranged by Pfizer and Lilly.

  • Patient consent Not requested since this is a register based study

  • Ethics approval This study was approved by the Ethical Committee in Stockholm, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.