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Prediction of Long-Term Mortality in Patients with Rheumatoid Arthritis according to Simple Questionnaire and Joint Count Measures

Theodore Pincus, MD; Raye H. Brooks, BS; and Leigh F. Callahan, PhD
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From Vanderbilt University School of Medicine, Nashville, Tennessee. Requests for Reprints: Theodore Pincus, MD, Vanderbilt University School of Medicine, Department of Medicine, Division of Rheumatology and Immunology, T-3219 Medical Center North, Nashville, TN 37232. Acknowledgments: The authors thank Stewart B. Marcum, Annette M. Oeser, and Brigitta Brannon for helpful technical support; and Dr. David Felson for helpful comments. Grant Support: The Jack C. Massey Foundation, Sandoz Pharma Ltd., grant AM-21393 from the National Institutes of Health to the American Rheumatism Association Medical Information System, and grant 5M01RR-0095 from the National Institutes of Health General Clinical Research Centers.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;120(1):26-34. doi:10.7326/0003-4819-120-1-199401010-00005
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Objective: To describe mortality over 15 years in a cohort of patients with rheumatoid arthritis, according to a simple questionnaire and joint count.

Design: A cohort study with 15 years of follow-up.

Setting: University hospital outpatient clinic.

Patients: A cohort of 75 patients with rheumatoid arthritis.

Measurements: Quantitative baseline measures: demographic, articular (joint counts), clinical, questionnaire, and physical measures, including modified questionnaire and joint count measures with substantially fewer items.

Results: Although few deaths were seen in the first 3 years after baseline, the standard mortality ratio over 15 years was 1.62, similar to findings in other series. Significant predictors of mortality included age, formal education level, joint count, activities-of-daily-living questionnaire scores, disease adjustment scores, morning stiffness, comorbid cardiovascular disease, grip strength, modified walking time, and button test. Five-year survival in patients with the poorest status according to these quantitative measures was 40% to 60%, comparable to expected survival at that time of patients with three-vessel coronary artery disease or with stage 4 Hodgkin disease. Simplified measures, including a count using only 28 joints and a questionnaire using only 8 activities of daily living, were similar to the more elaborate traditional measures for predicting mortality.

Conclusion: Higher mortality rates in patients with rheumatoid arthritis are predicted by more severe clinical disease, as in other chronic diseases. Severe rheumatoid arthritis may be identified using quantitative functional status questionnaires and joint counts, which can be ascertained in about 10 to 15 minutes in any clinical setting.

Figures

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Figure 1.
Survival in 75 patients with rheumatoid arthritis during 15 years according to demographic variables.

The variables included age, gender, and formal education level.

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Grahic Jump Location
Figure 2.
Survival in 75 patients with rheumatoid arthritis over 15 years according to disease variables.

The variables included duration of disease, status of joints (joint count), morning stiffness, comorbid cardiovascular disease, parenteral gold use, and oral corticosteroid use.

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Grahic Jump Location
Figure 3.
Survival in 75 patients with rheumatoid arthritis over 15 years according to measures of functional status.

The variables included modified walking time, button test, grip strength (men and women), questions about activities of daily living, and adjustment index.

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Grahic Jump Location
Figure 4.
Survival in 75 patients with rheumatoid arthritis over 15 years according to responses to questions about activities of daily living with 87, 20, or 8 included activities.

ADL = activities of daily living; HAQ = Health Assessment Questionnaire; and MHAQ = modified HAQ.

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Grahic Jump Location
Figure 5.
Survival in 75 patients with rheumatoid arthritis over 15 years according to joint counts.

Joint counts included 50, 36, 28, 12, and 6 joints or 1 or 2 knees.

Grahic Jump Location

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