AB0252 Mortality in Patients with Rheumatoid Arthritis: A Prospective Cohort Study over Two Years

Background Rheumatoid arthritis (RA) patients have an increased risk of mortality, which has been partially attributed to higher cardiovascular mortality. Objectives To determine the mortality and their risk factors over 2 years of follow up in a cohort study. Methods A total of 406 RA patients and 209 age and sex-matched normal controls enrolled in the KNUH Atherosclerosis Risk in RA (KARRA) cohort was assessed according to a standardized protocol for two years. Demographic data, traditional CV risk factors, and clinical and laboratory variables relevant to disease activity were obtained. Erythrocyte sedimentation rate-area under the curve (ESR-AUC) overtime was calculated to assess the inflammatory burden. The carotid intima-media thickness (IMT) and plaques were measured using carotid artery ultrasound. Results Among RA patients, a total 10 deaths (1.25% per year) occurred during 2 years follow-up period while there were no deaths among the controls. Disease duration of RA until deaths was 32.3±34.0 years. Causes of death included infection (4 pneumonia and 2 septic shock), sudden cardiac death (1 patient), congestive heart failure (1 patient), and others (2 patients). Risk factors for mortality included age (alive vs. dead patients: 55±12.1 vs. 71±9.5, p<0.001), functional class of RA (1.9±0.5 vs. 2.4±0.5, p<0.001), modified Korean health assessment questionnaire (mKHAQ) (9.6±7.8 vs. 22.1±13.7, p<0.05), DAS28 (3.3±4.5 vs. 4.6±1.3, p<0.006), ESR (23.3±20.1 vs 64.3±38.2, p<0.01), ESR-AUC (2,005±1,874 vs 4,106±1,649, p<0.01), and carotid artery plaque number (0.7±1.3 vs 2.5±2.1, p<0.05). After multivariate analysis, mKHAQ and ESR were found to be significantly associated with mortality (p<0.01 and p<0.05, respectively). mKHAQ and ESR cut-off points were made using a receiver-operating characteristic (ROC)-curve. Among the patients with mKHAQ <19, no death occurred in patients with normal ESR, while 3 deaths in patients with abnormal ESR (Figure). Mortality was highest among patients with HAQ ≥19 and abnormal ESR (6 deaths among 41 patients, 14.6%). Conclusions These results suggest that functional outcome and inflammatory activity of RA have a critical prognostic impact and tight control of inflammation may improve survival in this population. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4620