It has been known for 40 years ago that rheumatoid arthritis (RA) is associated with reduced life expectancy,1 a finding confirmed by numerous studies.2-4 Most RA mortality studies compare observed deaths in patient cohorts with expected from reference populations or case controls. Because of differences in composition of study series, length of follow up, and means to express the findings, the figures are not fully comparable. Crude death rates, however, have not improved.3 ,4 In 1953, Cobb et al 1 reported a standardised mortality ratio (SMR) of 1.3; in the recent study by Wolfe et al5the SMR was 2.3. In this study we have made use of the Finnish nationwide sickness insurance statistics to follow up age specific mortality in women with chronic inflammatory joint diseases during a 17 year period.

Since 1966, the Sickness Insurance Act has provided for the prescription of drugs (glucocorticoids, non-steroidal anti-inflammatory drugs, and disease modifying antirheumatic drugs) free of charge, usually lifelong, for chronic inflammatory joint diseases (since 1987, 90% of the costs have been reimbursed). The scheme covers the entire population, and almost all patients with RA make use of it.6 Eligibility …