AB0165 MALIGNANCY AS PREDOMINANT CAUSE OF DEATH IN RHEUMATOID ARTHRITIS: REVIEW OF DATA FROM ‘BASILDON EARLY ARTHRITIS COHORT’

Abstract

BackgroundRheumatoid arthritis is a chronic inflammatory autoimmune condition historically linked to increased mortality with predominant contribution from cardiovascular, respiratory, infectious and neoplastic causes. There is evidence of decreasing cardiovascular mortality through improvements in preventative and treatment strategies. Recent literature has also suggested overall improvement in RA-associated mortality attributed to contemporary advances in disease control. There is a need to assess if such outcomes are reflected in the real world setting and to identify elements that continue to promote poorer outcomes.ObjectivesTo assess long-term outcome in patients diagnosed with rheumatoid arthritis from the ‘Early Arthritis Cohort’ at a district general hospital in UK.MethodsA retrospective cohort study was conducted on 185 patients newly diagnosed with rheumatoid arthritis between 2009 & 2013. Patients fulfilling the ACR/EULAR 2010 criteria were included. Anonymised data from the Basildon Early Arthritis registry was analysed. Measured parameters included patient demographics, disease activity score (DAS28), treatment regime, development of co-morbidity & mortality.ResultsComplete data was available for analysis in 171 patients. This comprised 60 men & 111 women with median age of 57 years (IQR 47 - 67 years) and median follow-up time of 90 months (IQR 63 - 108 months). Thirty nine percent were current or ex-smokers. At baseline, 40% of patients had DAS28 score > 5.1, this reduced to 2.5% at time of their last follow up. 74% of patients were in clinical remission at last follow up with 11.7% achieving drug-free remission, 40.4% remaining on single csDMARD, 29.8% on combination csDMARD & 18.1% on biologic therapy.Analysis of new comorbidities revealed cancer burden of 12.9% (22/171) with lung cancer having highest incidence (n= 9). Other comorbidities recorded were cardiovascular 11.1% (19/171), pulmonary 5.8% (10/171) and cerebrovascular disease 5.3% (9/171).A crude mortality rate of 19.3% (33/171) was observed in our cohort over a median period of 7.5 years follow-up. The incidence mortality rate was 174/10,000 person-years of follow-up and standardised mortality ratio was 2.09 (95% CI 1.44 – 2.86). Majority of patients died five or more years after initial diagnosis (67%) with most deaths occurring in the 6th year after disease onset. Patients in the mortality group had higher disease activity scores at their last follow-up compared to the remaining cohort (p=0.017).More deaths were recorded from underlying malignancy 7.6% (n= 13) than with cardiovascular disease 4.7% (n= 8). Eight out of 13 cases were identified as lung cancer deaths. Breast, bladder, pancreatic and ovarian cancer constituted remaining cases. Other causes of death were from chronic obstructive pulmonary disease (n= 3), dementia/frailty (n = 3), interstitial lung disease (n= 2), infection (n= 2), stroke (n = 1) and chronic liver disease (n= 1).ConclusionDespite achieving remission in majority of patients, long-term analysis reveals that mortality in this cohort is significantly elevated compared to the general population. To best of our knowledge this is the first real-world study showing malignancy as the predominant cause of morbidity and mortality in rheumatoid arthritis.References[1]Abhishek A, Nakafero G, Kuo CF, Mallen C, Zhang W, Grainge MJ & Doherty M. (2018). Rheumatoid arthritis and excess mortality: down but not out. A primary care cohort study using data from Clinical Practice Research Datalink. Rheumatology (Oxford, England), 57(6), 977–981.[2]Zhang Y, Lu N, Peloquin C, Dubreuil M, Neogi T, Aviña-Zubieta JA, Rai SK & Choi HK. (2017). Improved survival in rheumatoid arthritis: a general population-based cohort study. Annals of the rheumatic diseases, 76(2), 408–413.[3]Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, Mussolino ME, Hsu LL, Addou E, Engelgau MM & Gordon D. (2017). Decline in Cardiovascular Mortality: Possible Causes and Implications. Circulation research, 120(2), 366–380.Disclosure of InterestsNone declared