Mortality and risk factors in Japanese patients with rheumatoid arthritis: a 14-year observation of the IORRA cohort.

IF 1.9 4区医学 Q3 RHEUMATOLOGY

Modern Rheumatology Pub Date : 2025-08-01 DOI:10.1093/mr/roaf074

Naohiro Sugitani, Eiichi Tanaka, Eisuke Inoue, Eri Sugano, Moeko Ochiai, Katsunori Ikari, Ayako Nakajima, Hisashi Yamanaka, Masayoshi Harigai

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引用次数: 0

Abstract

Objectives: To investigate standardized mortality ratio (SMR), causes of death, and mortality risk factors in Japanese patients with rheumatoid arthritis (RA) between 2007 and 2021, representing the biological disease-modifying antirheumatic drug (bDMARD) era.

Methods: We analyzed Japanese patients in the Institute of Rheumatology, Rheumatoid Arthritis cohort. The SMR was calculated using the Japanese General Population Life Table. Multiple imputation methods were used for sensitivity analysis of lost to follow-up cases. Risk factors were analyzed using time-dependent Cox proportional hazards model.

Results: Among 10,613 patients with RA, 915 deaths occurred for 99,364.8 patient-years. Major causes of death were malignancy (27.8%), respiratory disease (22.3%), and cardiovascular disease (16.3%). The SMR varied based on lost to follow-up assumptions: 0.92 (95% confidence interval (CI): 0.86 to 0.98) assuming all survived, 1.57 (95% CI: 1.47 to 1.68) assuming lost cases had equal mortality to followed cases, and 1.68 (95% CI: 1.58 to 1.79) assuming 1.65-times higher mortality than followed cases, respectively. Time-dependent analysis revealed protective associations with methotrexate (MTX) and bDMARDs, while even low-dose glucocorticoids showed increased mortality risk.

Conclusion: Japanese patients with RA show excess mortality despite bDMARD-era treatments. MTX and bDMARDs were protective, while glucocorticoids increased mortality risk.

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日本类风湿关节炎患者的死亡率和危险因素：IORRA队列的14年观察

目的：调查2007年至2021年间日本类风湿关节炎（RA）患者的标准化死亡率（SMR）、死亡原因和死亡危险因素，这代表了生物疾病改善抗风湿药物（bDMARD）时代。方法：我们分析了类风湿关节炎研究所的日本患者。SMR是使用日本一般人口寿命表计算的。采用多种方法对失访病例进行敏感性分析。危险因素分析采用时变Cox比例风险模型。结果：在10,613例RA患者中，99,364.8例患者年中有915例死亡。主要死亡原因为恶性肿瘤（27.8%）、呼吸系统疾病（22.3%）和心血管疾病（16.3%）。SMR的变化基于失访假设：0.92（95%置信区间（CI）： 0.86至0.98）假设所有患者存活，1.57 （95% CI: 1.47至1.68）假设失访病例与随访病例死亡率相等，1.68 （95% CI: 1.58至1.79）假设死亡率比随访病例高1.65倍。时间依赖性分析显示，甲氨蝶呤（MTX）和bDMARDs具有保护作用，而即使是低剂量的糖皮质激素也显示出死亡风险增加。结论：尽管bdmard时代的治疗，日本RA患者的死亡率仍然很高。甲氨蝶呤和bDMARDs具有保护作用，而糖皮质激素则增加了死亡风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Modern Rheumatology RHEUMATOLOGY-

CiteScore

4.90

自引率

9.10%

发文量

146

审稿时长

1.5 months

期刊介绍： Modern Rheumatology publishes original papers in English on research pertinent to rheumatology and associated areas such as pathology, physiology, clinical immunology, microbiology, biochemistry, experimental animal models, pharmacology, and orthopedic surgery. Occasional reviews of topics which may be of wide interest to the readership will be accepted. In addition, concise papers of special scientific importance that represent definitive and original studies will be considered. Modern Rheumatology is currently indexed in Science Citation Index Expanded (SciSearch), Journal Citation Reports/Science Edition, PubMed/Medline, SCOPUS, EMBASE, Chemical Abstracts Service (CAS), Google Scholar, EBSCO, CSA, Academic OneFile, Current Abstracts, Elsevier Biobase, Gale, Health Reference Center Academic, OCLC, SCImago, Summon by Serial Solutions