Abstract Background/Aims There is an increased mortality rate associated with RA. Previously, cardiovascular disease (CVD) has been identified as the major cause of mortality in patients with RA. The management of CVD has markedly improved over recent decades, with the recognition of acute coronary syndrome using high sensitive troponin assays and the early use of coronary artery stenting and bypass surgery. Enhanced therapies for cardiac failure have further reduced cardiovascular mortality. Consequently the causes of death in patients with RA may have shifted over the past two decades. Methods The data in this study were collected as part of project IRAS ID 194833, approved by South West regional ethical committee (UK). The cohort consisted of men attending routine rheumatology clinics at the Royal Cornwall Hospital, Cornwall, UK, from February 2015 to August 2016. All patients fulfilled 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA criteria at diagnosis. Data were anonymised at source. The men were followed up for 10 years and mortality was recorded; where possible the cause of mortality was ascertained from hospital notes or death certificates. Results A total of 247 deaths were recorded over a 10-year period in a cohort of 667 males with RA. Therefore 37% of the cohort of RA males died over a 10-year period. The annualised death rate was 3.7 %/year. Two hundred deaths were analysed further. The single most common type of death was respiratory in origin. There were 67/200 (33.5%) respiratory deaths. In addition, there were 15 deaths due to lung cancer 15/200 (7.5%). Any other type of cancer accounted for 35/200 (17.5%) deaths. CVD only accounted for 12/200 (6%) deaths. The rest of the deaths (71/200 35.5%) were because of frailty, dementia, fracture of the femur and sepsis. Conclusion Respiratory disease and lung cancer account for 41% of all the deaths. CVD only accounted for 6% of deaths. Greater emphasis should be placed on the respiratory system by routinely inquiring about respiratory symptoms at each consultation and performing regular chest auscultation to detect any basal crepitations. The use of hand held spirometers in clinic should be encouraged, along with a strong focus on joint rheumatology and respiratory clinics, smoking cessation programmes and ensuring that Influenza, pneumococcal, and COVID -19 vaccinations are up to date. Disclosure M. Dissanayake: None. D. Hutchinson: None.
Dissanayake et al. (Wed,) studied this question.