Rheumatoid Arthritis - Epidemiology
Abstract #385 All Cause And Cause Specific Mortality In Rheumatoid Arthritis (RA): A 25 Year Study of 1,865 RA Patients
F Wolfe, DJ Hawley, J Anderson Wichita, KS
Investigators from Wichita, Kansas investigated the mortality pattern of 1865 patients with rheumatoid arthritis who had been followed for up to 25 years. 624 deaths were recorded. A 2-fold greater risk of death (Standardized Mortality Radio [SMR] 1.94) was observed among this cohort of RA patients compared to normative values derived from US census data. The 3 leading causes of death among the RA patients were cardiovascular, respiratory and malignancy, though excess risk relative to the census data was only observed for the cardiovascular (SMR 1.99) and respiratory (SMR 3.76) causes of deaths.
Editorial Comments: These results are informative of (a) the predictive value of clinical variables, such as WBC count, sedimentation rate, Health Assessment Questionnaire status, and blood pressure toward mortality in RA, variables that can be modified by medical care, and (b) the lack of excess risk for cancer mortality in such a large group of RA patients relative to census data for persons without RA.
Abstract #388 Prednisone Use Significantly Increases The Risk Of Cataracts In Rheumatoid Arthritis
G Singh, JD Schettler, D Ramey, JB Wong Palo Alto, CA, Boston, MA
Prednisone is commonly used in the management of rheumatoid arthritis. To quantify the risk associated with prednisone use in the development of cataract among patients with RA, the investigators studied 4,993 consecutive patients in a large cohort enrolled at university and private practice centers in the US and Canada. 58% of the cohort was managed with prednisone at some point during 24,490 person-years of follow-up. The average dose of prednisone was 6.8 mg per day. Prednisone use was in fact strongly related to the development of cataract. Those participants with lifetime consumption of >10 grams of prednisone and current users of prednisone faced an approximately 2-fold increased risk of cataract. Cessation of prednisone did result in a lowering of this risk, but this risk still remained elevated (RR 1.8) relative to participants who had never used prednisone.
Editorial Comment: These findings reinforce the sequelae of long-term use of corticosteroids in patients with rheumatoid arthritis, even when steroids are prescribed at a modest level.
Abstract #895 Predictors And Consequences Of Adverse Drug Reactions (ADRs) In The Clinic
F Wolfe, S Zhao Wichita, KS, Skokie, IL
The investigators examined the clinical and economic impact of mild ADRs among 638 patients with RA and 163 with OA, evaluated during 4,520 consecutive clinic visits between November 1992 and March 1999. The frequency of ADRs was 16.3% and 14.6% among the RA and OA patients, respectively. In multivariate analysis adjusted for multiple clinical and demographic parameters, only age and fatigue or anxiety were associated with ADRs. Surprisingly, it was the younger, and not the older, patients that demonstrated a greater frequency of ADRs. Side effects were present for a median of 17.5 days, and 40% of patients with ADRs received treatment for their side effects. 37% of those with side effects discontinued their medication; 3.2% of patients lost work due to these side effects. The predominant organ system manifesting side effects was the GI tract.
Editorial Comments: These findings are informative in describing the frequency and profile of side effects in patients receiving therapy for RA and OA