Study looked at rates of mortality after 23 years follow-up

The results of a 23-year, follow-up study presented at the Annual European Congress of Rheumatology (EULAR 2018) suggest early, intensive treatment of rheumatoid arthritis has long-term benefits including the normalisation of mortality to levels consistent with the general population.1

“We know that the adverse effects of rheumatoid arthritis on the body only become truly apparent after more than a decade,” said Professor Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR. “Therefore, it is really interesting to see these data supporting early therapy after such a long period of follow-up.”

Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. It can also affect internal organs. Rheumatoid arthritis is more common in older people, but there is also a high prevalence in young adults, adolescents and even children, and it affects women more frequently than men.

Mortality in patients with RA is higher than in the general population.2,3,4 There have been many advances in management which have demonstrated improved morbidity rates, however evidence of improved mortality rates has remained elusive.5

“Our results confirm that early, intensive treatment of rheumatoid arthritis, including use of glucocorticoids, has long-term benefits”, said Professor Maarten Boers, VU University Medical Center, Amsterdam, The Netherlands (study author). “Importantly, this study is one of the first to show a normalisation of RA mortality compared to the general population after 23 years of follow-up.”

This prospective study looked at the rate of mortality after 23 years follow-up of the COBRA (COmbinatietherapie Bij Rheumatoide Artritis) trial. In the original study,6 patients with early RA were treated with sulphalasazine (SSZ) monotherapy or a combination of SSZ, low-dose methotrexate and initially high, step-down prednisolone. Results demonstrated the combined therapy regimen offered additional disease control over SSZ alone. In 2010, after 11 years of follow up, another study showed numerically (but not significantly) lower mortality in patients on the combined therapy regimen compared to patients with SSZ monotherapy.7

The current study included data from 154 of the 155 original patients with a mean follow-up time of 23 years (in those that did not die). Using a reference sample matched for age and gender, investigators demonstrated numerically (but not significantly) lower mortality of the study participants (44/154, 28%) compared to the general population (55/154, 35%). Within the study population, 20/75 (27%) died who were randomised to the combined therapy regimen, and 24/79 (30%) on SSZ alone. The difference between the two therapeutic approaches was not significant and the positive trend for combined therapy over SSZ decreased over time.1

Source: European League Against Rheumatism (EULAR)

Full bibliographic information

1 Poppelaars PBM, van Tuyl LHD, and Boers M. Mortality of the COBRA early rheumatoid arthritis trial cohort after 23 years follow up. EULAR 2018; Amsterdam: Abstract OP0015.
2 Gabriel SE. The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am. 2001;27:269–81.
3 Guedes C, Dumont-Fischer D, Leichter-Nakache S, et al. Mortality in rheumatoid arthritis. Rev Rhum Engl Ed. 1999;66:492–8.
4 Pincus T, Callahan LF. Taking mortality in rheumatoid arthritis seriously: predictive markers, socioeconomic status and comorbidity. J Rheumatol. 1986;13:841–5.
5 Dadoun S, Zeboulon-Ktorza N, Combescure C, et al. Mortality in rheumatoid arthritis over the last fifty years: Systematic review and meta-analysis. Joint Bone Spine 2013;80:29-33.
6 Boers M, Verhoeven AC, Markusse HM, et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet. 1997;350(9074):309-18.
7 van Tuyl LH1, Boers M, Lems WF, et al. Survival, comorbidities and joint damage 11 years after the COBRA combination therapy trial in early rheumatoid arthritis. Ann Rheum Dis. 2010;69(5):807-12.
8 van der Heijde D, et al. Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers and other stakeholders endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). Annals of the Rheumatic Diseases. 2018;doi:10.1136/annrheumdis-2017-212565. [Epub ahead of print].
9 EULAR.
10 things you should know about rheumatic diseases fact sheet. Available at: https://www.eular.org/myUploadData/files/10%20things%20on%20RD.pdf [Last accessed April 2018].