Women with Rheumatoid Arthritis at Greater Risk of Dying from Respiratory Disease

Compared to women without rheumatoid arthritis (RA), women with the disease are at a higher risk of all cause mortality, and specifically respiratory mortality, according to research presented at the 2014 American College of Rheumatology Annual Meeting held November 14-19 in Boston, MA.

Researchers from Brigham and Women’s Hospital and Harvard Medical School collected data from the Nurses’ Health Study, which incorporated data from 121,700 women from 1976 to 2012. The investigators identified 964 incident RA cases and 28,808 deaths within the entire study in addition to 26 years of follow up data.

There were 307 deaths among women with RA; 26 percent were from cancer, 23 percent were from cardiovascular disease, and 16 percent were from respiratory causes. Women without RA in the original study died from the following: 41 percent from cancer, 22 percent from cardiovascular disease, and 7 percent from respiratory causes.

“We aimed to study deaths and causes of death in a cohort in which women have been followed very closely before and after development of RA and directly compared to women without RA,” explained lead author Jeffrey Sparks, MD, from Brigham and Women’s. “All the participants in this study had repeated assessment of behavioral factors, such as cigarette smoking, comorbid diseases such as cardiovascular disease, and other mortality risk factors, enabling us to study the independent effect of having RA on the risk of death.”

The researchers concluded women with RA had 40 percent increased mortality from all causes, once the data was adjusted for age and other mortality risk factors. The researchers believed this may have been influenced by cardiovascular and respiratory causes, but cancer did not appear to play a role. The authors highlighted the fact that women with seropositive RA had significantly 51 percent higher risk of death than compared to their non RA counterparts.

Women with seropositive RA had nearly 3 times the mortality risk in respiratory causes, such as chronic obstructive pulmonary disease (COPD), pneumonia, chronic interstitial lung disease, asthma, and other respiratory diseases, than women without RA. It appeared that every 5 years of having RA would increase the women’s mortality by 11 percent, compared to women without the disease. However, the mortality rate in seronegative RA women was not statistically different from their non RA counterparts.

“This study highlights the clinical necessity of recognizing and addressing complications of RA, such as respiratory disease and cardiovascular disease, which associated with early mortality,” Sparks concluded.

Respiratory death is an understudied cause of death in the current literature about women with RA, and especially seropositive RA, the authors believe. But they feel their data showed RA related respiratory as a valid mortality risk, when traditional respiratory causes of death like smoking are typically considered.