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Lotta Ljung, Marie Holmqvist, Addressing the hardest endpoint, Rheumatology, Volume 59, Issue 3, March 2020, Pages 462–463, https://doi.org/10.1093/rheumatology/kez514
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This editorial refers to ‘Trends in all-cause and cardiovascular mortality in patients with incident rheumatoid arthritis: a 20-year follow-up matched case-cohort study’, by Sella A. Provan et al., on pages 505–512.
Mortality is the hardest of endpoints. RA is, for a majority of patients, a life-long disease, and is also known to be associated with an increased risk of death [1]. In this issue of Rheumatology, Provan et al. [2] aim to answer this research question in a contemporary patient population.
Patients with RA have an increased risk of comorbid conditions, and the increased risk of death attributed to RA can be viewed as the result of the accumulated burden of the disease. Cardiovascular diseases with atherosclerotic aetiology are the dominating underlying causes of death in most populations, and among patients with RA, there is an excess mortality risk from coronary disease or stroke of ∼50% [3]. The development of a comorbidity, such as cardiovascular disease, diabetes mellitus, obstructive pulmonary disease or osteoporosis, is related to the course of the rheumatoid disease: the inflammation, as well as the presence of extra-articular RA disease manifestations [4]. Measures aimed at normalizing the life span for patients with RA therefore need to be directed to the RA disease, as well as to risk factors for specific comorbidities.
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