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Causes of death in patients with rheumatoid arthritis autopsied during a 40-year period

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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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References

  1. Cobb S, Anderson F, Bauer W (1953) Length of life and cause of death in rheumatoid arthritis. N Engl J Med 249:553–556

    PubMed  CAS  Google Scholar 

  2. Allebeck P (1982) Increased mortality in rheumatoid arthritis. Scand J Rheumatol 11:81–86. doi:10.3109/03009748209098167

    Article  PubMed  CAS  Google Scholar 

  3. Vandenbroucke JP, Hazevoet HM, Cats A (1984) Survival and cause of death in rheumatoid arthritis: a 25-year prospective followup. J Rheumatol 11:158–161

    PubMed  CAS  Google Scholar 

  4. Prior P, Symmons DP, Scott DL, Brown R, Hawkins CF (1984) Cause of death in rheumatoid arthritis. Br J Rheumatol 23:92–99. doi:10.1093/rheumatology/23.2.92

    Article  PubMed  CAS  Google Scholar 

  5. Mutru O, Laakso M, Isomaki H, Koota K (1985) Ten year mortality and causes of death in patients with rheumatoid arthritis. Br Med J (Clin Res Ed) 290:1797–1799

    Article  CAS  Google Scholar 

  6. Symmons DP, Jones MA, Scott DL, Prior P (1998) Longterm mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well. J Rheumatol 25:1072–1077

    PubMed  CAS  Google Scholar 

  7. Riise T, Jacobsen BK, Gran JT, Haga HJ, Arnesen E (2001) Total mortality is increased in rheumatoid arthritis. A 17-year prospective study. Clin Rheumatol 20:123–127. doi:10.1007/PL00011191

    Article  PubMed  CAS  Google Scholar 

  8. Bjornadal L, Baecklund E, Yin L, Granath F, Klareskog L, Ekbom A (2002) Decreasing mortality in patients with rheumatoid arthritis: results from a large population based cohort in Sweden, 1964–95. J Rheumatol 29:906–912

    PubMed  Google Scholar 

  9. Sihvonen S, Korpela M, Laippala P, Mustonen J, Pasternack A (2004) Death rates and causes of death in patients with rheumatoid arthritis: a population-based study. Scand J Rheumatol 33:221–227. doi:10.1080/03009740410005845

    Article  PubMed  CAS  Google Scholar 

  10. Goodson N, Marks J, Lunt M, Symmons DP (2005) Cardiovascular admissions and mortality in an inception cohort of patients with rheumatoid arthritis with onset in the 1980s and 1990s. Ann Rheum Dis 64:1595–1601. doi:10.1136/ard.2004.034777

    Article  PubMed  CAS  Google Scholar 

  11. Sokka T, Mottonen T, Hannonen P (1999) Mortality in early “sawtooth” treated rheumatoid arthritis patients during the first 8–14 years. Scand J Rheumatol 28:282–287. doi:10.1080/03009749950155463

    Article  PubMed  CAS  Google Scholar 

  12. Davis RF, Engleman EG (1974) Incidence of myocardial infarction in patients with rheumatoid arthritis. Arthritis Rheum 17:527–533. doi:10.1002/art.1780170506

    Article  PubMed  CAS  Google Scholar 

  13. Mutru O, Koota K, Isomaki H (1976) Causes of death in autopsied RA patients. Scand J Rheumatol 5:239–240. doi:10.3109/03009747609099912

    Article  PubMed  CAS  Google Scholar 

  14. Wicks IP, Moore J, Fleming A (1988) Australian mortality statistics for rheumatoid arthritis 1950–81: analysis of death certificate data. Ann Rheum Dis 47:563–569

    Article  PubMed  CAS  Google Scholar 

  15. Krishnan E, Lingala VB, Singh G (2004) Declines in mortality from acute myocardial infarction in successive incidence and birth cohorts of patients with rheumatoid arthritis. Circulation 110:1774–1779. doi:10.1161/01.CIR.0000142864.83780.81

    Article  PubMed  Google Scholar 

  16. Suzuki A, Ohosone Y, Obana M, Mita S, Matsuoka Y, Irimajiri S et al (1994) Cause of death in 81 autopsied patients with rheumatoid arthritis. J Rheumatol 21:33–36

    PubMed  CAS  Google Scholar 

  17. Welsh TS, Kaplan J (1998) The role of postmortem examination in medical education. Mayo Clin Proc 73:802–805

    PubMed  CAS  Google Scholar 

  18. Roulson J, Benbow EW, Hasleton PS (2005) Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review. Histopathology 47:551–559

    PubMed  CAS  Google Scholar 

  19. Koivuniemi R, Leirisalo-Repo M, Suomalainen R, Piirainen H, Paimela L (2006) Infectious causes of death in patients with rheumatoid arthritis: an autopsy study. Scand J Rheumatol 35:273–276. doi:10.1080/03009740600556258

    Article  PubMed  CAS  Google Scholar 

  20. Pritt BS, Hardin NJ, Richmond JA, Shapiro SL (2005) Death certification errors at an academic institution. Arch Pathol Lab Med 129:1476–1479

    PubMed  Google Scholar 

  21. McFarlane MJ (1987) Absence of demographic bias in selection for necropsy. Arch Pathol Lab Med 111:67–70

    PubMed  CAS  Google Scholar 

  22. McFarlane MJ, Feinstein AR, Wells CK, Chan CK (1987) The ‘epidemiologic necropsy’. Unexpected detections, demographic selections, and changing rates of lung cancer. JAMA 258:331–338. doi:10.1001/jama.258.3.331

    Article  PubMed  CAS  Google Scholar 

  23. Cameron HM, McGoogan E, Watson H (1980) Necropsy: a yardstick for clinical diagnoses. BMJ 281:985–988

    PubMed  CAS  Google Scholar 

  24. Podbregar M, Voga G, Krivec B, Skale R, Pareznik R, Gabrscek L (2001) Should we confirm our clinical diagnostic certainty by autopsies? Intensive Care Med 27:1750–1755. doi:10.1007/s00134-001-1129-x

    Article  PubMed  CAS  Google Scholar 

  25. Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Roger VL, Jacobsen SJ et al (2005) Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum 52:402–411. doi:10.1002/art.20853

    Article  PubMed  Google Scholar 

  26. Douglas KM, Pace AV, Treharne GJ, Saratzis A, Nightingale P, Erb N et al (2006) Excess recurrent cardiac events in rheumatoid arthritis patients with acute coronary syndrome. Ann Rheum Dis 65:348–353. doi:10.1136/ard.2005.037978

    Article  PubMed  CAS  Google Scholar 

  27. Salonen JT, Puska P, Kottke TE, Tuomilehto J, Nissinen A (1983) Decline in mortality from coronary heart disease in Finland from 1969 to 1979. Br Med J (Clin Res Ed) 286:1857–1860

    CAS  Google Scholar 

  28. Martio J (1993) Onko tulehduskipulääkkeiden käyttöä arvioitava uudelleen? Duodecim 109:1795–1805

    PubMed  CAS  Google Scholar 

  29. Hermann M, Ruschitzka F (2007) Cardiovascular risk of cyclooxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs. Ann Med 39:18–27. doi:10.1080/07853890601073445

    Article  PubMed  CAS  Google Scholar 

  30. Van Doornum S, McColl G, Wicks IP (2002) Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis? Arthritis Rheum 46:862–873. doi:10.1002/art.10089

    Article  PubMed  Google Scholar 

  31. Choi HK, Hernan MA, Seeger JD, Robins JM, Wolfe F (2002) Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 359:1173–1177. doi:10.1016/S0140-6736(02)08213-2

    Article  PubMed  CAS  Google Scholar 

  32. Dixon WG, Symmons DP (2007) What effects might anti-TNFalpha treatment be expected to have on cardiovascular morbidity and mortality in rheumatoid arthritis? A review of the role of TNFalpha in cardiovascular pathophysiology. Ann Rheum Dis 66:1132–1136. doi:10.1136/ard.2006.063867

    Article  PubMed  CAS  Google Scholar 

  33. Walji S, Bykerk VP (2004) Rheumatoid arthritis: is the disease becoming milder or is treatment improving? J Rheumatol 31:1023–1025

    PubMed  Google Scholar 

  34. Kvalvik AG, Jones MA, Symmons DP (2000) Mortality in a cohort of Norwegian patients with rheumatoid arthritis followed from 1977 to 1992. Scand J Rheumatol 29:29–37. doi:10.1080/030097400750001770

    Article  PubMed  CAS  Google Scholar 

  35. Allebeck P, Ahlbom A, Allander E (1981) Increased mortality among persons with rheumatoid arthritis, but where RA does not appear on death certificate. Eleven-year follow-up of an epidemiological study. Scand J Rheumatol 10:301–306. doi:10.3109/03009748109095320

    Article  PubMed  CAS  Google Scholar 

  36. Laakso M, Isomaki H, Mutru O, Koota K (1986) Death certificate and mortality in rheumatoid arthritis. Scand J Rheumatol 15:129–133. doi:10.3109/03009748609102078

    Article  PubMed  CAS  Google Scholar 

  37. Tiitinen S, Kaarela K, Filipowicz-Sosnowska A, Maczynska-Rusiniak B, Lehtinen K, Leirisalo-Repo M et al (1992) HLA typing and seropositivity in Finnish and in Polish patients with rheumatoid arthritis and amyloidosis. Clin Rheumatol 11:265–268. doi:10.1007/BF02207970

    Article  PubMed  CAS  Google Scholar 

  38. Teilum G, Lindahl A (1954) Frequency and significance of amyloid changes in rheumatoid arthritis. Acta Med Scand 149:449–455

    PubMed  CAS  Google Scholar 

  39. Wright JR, Calkins E (1981) Clinical-pathologic differentiation of common amyloid syndromes. Medicine (Baltimore) 60:429–448. doi:10.1097/00005792-198101000-00001

    Article  CAS  Google Scholar 

  40. Zaitoun AM, Fernandez C (1998) The value of histological examination in the audit of hospital autopsies: a quantitative approach. Pathology 30:100–104. doi:10.1080/00313029800169036

    Article  PubMed  CAS  Google Scholar 

  41. Kircher T, Nelson J, Burdo H (1985) The autopsy as a measure of accuracy of the death certificate. N Engl J Med 313:1263–1269

    PubMed  CAS  Google Scholar 

  42. Sington JD, Cottrell BJ (2002) Analysis of the sensitivity of death certificates in 440 hospital deaths: a comparison with necropsy findings. J Clin Pathol 55:499–502

    PubMed  CAS  Google Scholar 

  43. Singh G (1998) Recent considerations in nonsteroidal anti-inflammatory drug gastropathy. Am J Med 105:31S–38S. doi:10.1016/S0002-9343(98)00072-2

    Article  PubMed  CAS  Google Scholar 

  44. Paimela H, Paimela L, Myllykangas-Luosujarvi R, Kivilaakso E (2002) Current features of peptic ulcer disease in Finland: incidence of surgery, hospital admissions and mortality for the disease during the past twenty-five years. Scand J Gastroenterol 37:399–403. doi:10.1080/003655202317316015

    Article  PubMed  CAS  Google Scholar 

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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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Correspondence to R. Koivuniemi.

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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

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