Abstract
We studied causes of death (CoDs) between 1952 and 1991 assessed by a clinician before autopsy and then determined at autopsy by a pathologist in 369 subjects with rheumatoid arthritis (RA) and 370 subjects without RA (non-RA). We analysed clinical data for RA subjects between 1973 and 1991. In RA subjects, leading autopsy-based CoDs were RA, cardiovascular diseases and infections. Between diagnoses of CoDs by the clinician and those determined by the pathologist, RA subjects had lower agreement than did the non-RA regarding coronary deaths (Kappa reliability measure: 0.33 vs. 0.46). In non-RA subjects, autopsy-based coronary deaths showed a decline since the 1970s with no such decline in RA. Between subjects treated at any time during RA with disease-modifying anti-rheumatic drugs and those without, autopsy-based CoDs were similar. Coronary death being less accurately diagnosed in RA subjects may indicate that coronary heart disease in RA patients often remains unrecognized.
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Acknowledgments
We thank Drs. T. Polvikoski and M. Tanskanen from the Department of Pathology of Helsinki University Central Hospital for their valuable advice. We thank BA Hannu Kautiainen for statistical assistance. We also thank Markku Tamminen for technical support. This study was supported by the National Graduate School of Musculoskeletal Disorders and Biomaterials and by grants from the Helsinki University Central Hospital Research Funds, the Wilhelm and Else Stockmann Foundation, and the Research Foundation of the Orion Corporation.
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Koivuniemi, R., Paimela, L., Suomalainen, R. et al. Causes of death in patients with rheumatoid arthritis autopsied during a 40-year period. Rheumatol Int 28, 1245–1252 (2008). https://doi.org/10.1007/s00296-008-0685-6
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DOI: https://doi.org/10.1007/s00296-008-0685-6