To investigate if, and when, patients diagnosed with rheumatoid arthritis (RA) in recent years are at increased risk of death.
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.
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.
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.
Diet has gained attention as a risk factor for the development of rheumatoid arthritis (RA), especially with regards to food of animal origin, such as meat and dairy products. By using data from ...national patient registers and dietary data from a large prospective population cohort, the Swedish Mammography Cohort, we aimed to investigate whether the consumption of meat and dairy products had any impact on the risk of subsequent development of RA. During 12 years of follow-up (January 2003-December 2014; 381, 456 person-years), 368 patients with a new diagnosis of RA were identified. No associations between the development of RA and the consumption of meat and meat products (hazard ratio HR for the fully adjusted model: 1.08 95% CI: 0.77-1.53) or the total consumption of milk and dairy products (HR for the fully adjusted model: 1.09 95% CI: 0.76-1.55) were observed. In conclusion, in this large prospective cohort of women, no associations were observed between dietary intake of meat and dairy products and the risk of RA development.
Abstract
Objectives
To investigate the association between psychosocial vulnerability, defined as either low social support or low decision latitude at work, and disease remission at 3, 12, and 60 ...months in patients with rheumatoid arthritis (RA).
Methods
This cohort study included all patients enrolled in both the Swedish Epidemiological Investigation of Rheumatoid Arthritis (EIRA) 1996–2015 and the Swedish Rheumatology Quality Register (SRQ,
n
= 2820). Information on social support and decision latitude at work at RA diagnosis were identified from the EIRA questionnaire. Indexes for levels of social support and decision latitude at work, respectively, were calculated based on the questionnaire. Low social support and low decision latitude at work, respectively, were identified by a score in the lowest quartile and compared with the three other quartiles (not low). Disease-activity parameters were retrieved from SRQ at 3, 12, and 60 months. The associations between social support or decision latitude at work, respectively, and Disease Activity Score 28 joint count with C-reactive protein (DAS28-CRP) remission were analysed using logistic regression models adjusted for age, sex, smoking habits, alcohol habits, symptom duration, and educational level.
Results
Having low social support (
n
= 591) was not associated with DAS28-CRP remission at 3 (OR 0.93, 95% CI 0.74–1.16), 12 (OR 0.96, 95%CI 0.75–1.23), or 60 (OR 0.89, 95%CI 0.72–1.10) months compared to not low social support (
n
= 2209). No association was observed for low (
n
= 212) versus not low (
n
= 635) decision latitude at work and DAS28-CRP remission at 3 (OR 0.84, 95%CI 0.54–1.31), 12 (OR 0.81, 95%CI 0.56–1.16), or 60 (OR 1.37, 95%CI 0.94–2.01) months.
Conclusion
In a country with general access to healthcare, psychosocial vulnerability does not influence the likelihood of achieving remission in early RA.
Objectives
To study clinical characteristics, mortality, and secondary prevention, after a first incident acute myocardial infarction (AMI) in patients with ankylosing spondylitis (AS) compared with ...the general population.
Methods
In total, 292 subjects with AS and a first AMI between Jan 2006 and Dec 2014 were identified using the Swedish national patient register. Each subject was matched with up to 5 general population comparators per AS-patient (
n
= 1276). Follow-up started at the date of admission for AMI and extended until death or 365 days of follow-up. Cox regression was used to assess mortality in two time intervals: days 0–30 and days 31–365. For a subgroup with available data, clinical presentation at admission, course, treatment for AMI, and secondary prevention were compared.
Results
During the 365-day follow-up, 56/292 (19%) AS patients and 184/1276 (14%) comparators died. There were no difference in mortality due to cardiovascular-related causes, although the overall mortality day 31–365 was increased among patients with AS compared with comparators (HR 95% CI = 2.0 1.3;3.0). At admission, AS patients had a higher prevalence of cardiovascular comorbidities compared with comparators. At discharge, patients with AS were less often prescribed lipid-lowering drugs and non-aspirin antiplatelet therapy
.
Conclusions
Patients with AS tend to have a higher comorbidity burden at admission for first AMI. The mortality after a first AMI due to cardiovascular-related causes does not seem to be elevated, despite an increased overall mortality during days 31–365 among patients with AS compared with the general population.
Key Points
• The all-cause mortality after a first AMI was higher in patients with AS.
• Mortality after a first AMI due to CVD-related causes does not seem to be elevated for patients with AS.
• In patients with AS suffering a first AMI, more attention should be given to other comorbidities causing an excess in mortality.
Abstract
Background
In European axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) clinical registries, we aimed to investigate commonalities and differences in (1) set-up, clinical data ...collection; (2) data availability and completeness; and (3) wording, recall period, and scale used for selected patient-reported outcome measures (PROMs).
Methods
Data was obtained as part of the EuroSpA Research Collaboration Network and consisted of (1) an online survey and follow-up interview, (2) upload of real-world data, and (3) selected PROMs included in the online survey.
Results
Fifteen registries participated, contributing 33,948 patients (axSpA: 21,330 (63%), PsA: 12,618 (37%)). The reported coverage of eligible patients ranged from 0.5 to 100%. Information on age, sex, biological/targeted synthetic disease-modifying anti-rheumatic drug treatment, disease duration, and C-reactive protein was available in all registries with data completeness between 85% and 100%. All PROMs (Bath Ankylosing Spondylitis Disease Activity and Functional Indices, Health Assessment Questionnaire, and patient global, pain and fatigue assessments) were more complete after 2015 (68–86%) compared to prior (50–79%). Patient global, pain and fatigue assessments showed heterogeneity between registries in terms of wording, recall periods, and scale.
Conclusion
Important heterogeneity in registry design and data collection across fifteen European axSpA and PsA registries was observed. Several core measures were widely available, and an increase in data completeness of PROMs in recent years was identified. This study might serve as a basis for examining how differences in data collection across registries may impact the results of collaborative research in the future.
Acute coronary syndrome (ACS) and other cardiovascular diseases are the main drivers of the increased morbidity and preterm mortality in rheumatoid arthritis (RA). ACS in RA has been linked to ...inflammation and RA severity. During recent years and with new therapeutic options and treat-to-target strategies, increasing efforts have been made to reach RA remission as soon as possible after diagnosis, and the average level of RA disease activity has declined. Whether this has resulted in declining excess risks for RA comorbidities remains unclear.
We performed a nationwide population-based cohort study of patients with new-onset RA from 1997 to 2014, and matched general population comparators. In the Swedish healthcare system, all residents have equal access to healthcare services. Healthcare is monitored using high-quality population-based registers that can be linked together. 15 744 patients with new-onset RA, identified from the Swedish Rheumatology Quality Register, and 70 899 general population comparator subjects were included.
Seven hundred and seventy two patients with RA developed an ACS during 103 835 person-years of follow-up (crude incidence, 7.4 per 1000), corresponding to an overall HR versus the general population of 1.41 (95% CI 1.29 to 1.54). Whereas the ACS incidence declined over calendar time in both the RA and the general population cohort, the excess and the relative risks of ACS remained the same.
Despite improved disease control in new-onset RA, the elevated risk of ACS in RA remains a concern.
The risk of development of rheumatoid arthritis (RA) could be affected by immune activation in obesity. Our objective was to evaluate the association between obesity in general, and abdominal ...obesity, and the risk for subsequent development of RA.
In two large population-based, prospective cohorts, 557 cases (mean age at RA symptom onset 58, SD 10 years, 68% women) who subsequently developed RA and 1671 matched controls were identified. From a health examination antedating symptom onset (median 5.5 years), collected data on body mass index (BMI; kg/m
), smoking habits, and educational level was used in conditional logistical regression models. Corresponding regression models were used to analyse the association between waist circumference measurements (cm) and RA development in a subset of the population.
BMI and waist circumference were associated with the risk of RA development, adjusted odds ratio (OR) (95% CI), 1.13 (1.00, 1.28) per 5 kg/m
, and 1.02 (1.01, 1.04) per cm, respectively. An association was also observed for obesity (BMI ≥30) OR 1.45 (1.07, 1.95), compared with BMI <25. After stratification for sex the associations were enhanced in men, and attenuated in women. Among men with BMI above normal a 3-5 times increased risk for RA disease development at 50 years of age or earlier was observed. Abdominal obesity with waist circumference >102 cm was associated with a 2-3 times increased risk of RA, but not abdominal obesity (>88 cm) in women.
Obesity or abdominal obesity, respectively, was independently associated with a modest increase of the risk for subsequent development of RA. This appeared to be relevant mainly for early RA disease onset among men.
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