Outcome after 40 years with rheumatoid arthritis: a prospective study of function, disease activity, and mortality.

In an inception cohort of 100 patients with rheumatoid arthritis (RA) we studied course and outcome after 40 years, regarding function, disease activity, cause and age of death, and prognostic factors. Function, joint count, erythrocyte sedimentation rate (ESR), hemoglobin (Hb), rheumatoid factor (RF), and the number of orthopedic operations were measured in 100 consecutive referrals between 1957 and 1963 with either definite or classical RA at one year after onset of symptoms. Subjects have been followed for a mean of 40 years, or until death. In May 1999, 84 subjects had died. Of the 16 survivors, 8 (50%) were severely disabled from RA while 5 (31%) had normal function. The mean joint score had gradually increased over 40 years. Death was directly attributable to RA in 13, while RA or its treatment contributed to death in 11 subjects. In the other 60 deceased subjects, cardiovascular causes accounted for 28 deaths (33% of total deaths). Features at one year that were associated with mortality up to 40 years after onset by regression analysis were: older age (p < 0.0001), lower Hb (p = 0.0461), and worse function (p < 0.0001). The standardized mortality ratio of the cohort at 40 years was 2.13 (confidence interval 1.26-3.60), and median survival was reduced by 10 years for men and 11 years for women compared to the general population. In conclusion, RA is a progressive disease impairing function up to 40 years after onset, with shortened life span. The leading cause of death was cardiovascular disease.