Rheumatoid arthritis is associated with higher post-fracture mortality and fracture-related care

Objective Rheumatoid Arthritis (RA) is a potentially devastating autoimmune disease associated with multiple comorbidities, including osteoporosis (OP) and cardiovascular disease, which exert significant morbidity and mortality burdens. Despite the recognised connection between RA and fracture risk, few studies have evaluated post-fracture survival in RA, and no studies have evaluated RA's impact on post-fracture survival between 1990-2010 when there was a rapid growth in disease-modifying antirheumatic drugs (DMARD) availability in combination with a paradigm shift in the understanding of RA. Methods We performed a case-control matched retrospective cohort study of 1304 RA patients, using routinely collected administrative health data from public and private hospitals in Western Australia to assess survival after a first fracture. Results We found RA associated with a significant survival disadvantage after fracture (HR for death 1.28, 95% CI 1.18-1.39). In contrast to expectations, post fracture survival did not improve from 1990-1999 to 2000-2010 in RA patients or controls (HR RA 0.95; 95% CI 0.75-1.20 and HR controls 0.856; 95% CI 0.71-1.04). Further, we found that RA is a risk factor for increased odds of fracture-related re-presentations (OR 1.27, 95% CI 1.08-1.49). Conclusion Using data from hospitals in Western Australia, this study demonstrates that people with RA have worse survival after fracture, and, in contrast to expectation, this survival has not improved despite significant therapeutic advances over the past 40 years. Consequently, this study emphasises the need to better understand and treat fractures in RA to improve the lives of RA patients.