Rheumatoid arthritis (RA) affects approximately 1 of the US population, imposing enormous societal costs. Lifetime per patient cost is estimated to range between 61,000 and 122,000. Indirect costs are over twice those of direct expenses, leading to total RA-related costs of approximately 26 to 32 billion annually in the United States alone.91 Work-related disability represents the single largest societal burden, far surpassing total RA treatment costs. Consistent with a prior report of a 50 occurrence of disability after a mean follow-up of 20.9 years, 131 Sokka et al112 found that 44 of RA patients became work disabled within 10 years of follow-up. In addition to causing significant morbidity and posing a substantial economic burden, an increasing number of population-based studies have shown that RA leads to premature mortality. A 1996 review35 of mortality studies involving RA patients from 16 separate centers in North America and Europe revealed an increased mortality in all but one study.58 It has been estimated, for example, that RA reduces average life expectancy by 7 years for men and 3 years for women.122 In 1994, Wolfe and colleagues132 examined mortality in 3501 RA patients derived from four separate cohorts, deriving an overall standardized mortality ratio of 2.26. Despite these disturbing statistics, the exact cause of this increased mortality has been incompletely characterized. In the last 15 years, great strides have been made in the treatment of RA. Methotrexate (MTX), a potent disease-modifying antirheumatic drug (DMARD) approved for the treatment of RA in the mid-1980s, represents one such advance. MTX compares favorably with other standard DMARDs in terms of tolerability and efficacy25; as a result, it has a substantially higher rate of continued use.88 MTX has become widely accepted in the rheumatology community and is currently the most commonly prescribed first-line DMARD in the United States.67 This important therapeutic advance, however, has not clearly translated into lower mortality for RA patients. Gabriel and colleagues29 recently reported on findings from three prevalence cohorts from Olmstead County, Minnesota. The population-based cohorts, defined in 1965, 1975, and 1985, respectively, included 272 RA patients with a median follow-up of 12.7 years. Although overall mortality improved significantly for the general Olmstead County population between 1965 and 1985, RA patients did not share a similar gain in life expectancy. In contrast to this temporal pattern for survival of the population at large, there was a trend toward diminished survival among RA patients in the 1975 and 1985 cohorts compared with the 1965 cohort (Fig. 1). Diminished survival coupled with rising related costs raises important and timely questions about the precise causes of the morbidity and mortality in the disease. RA is seldom implicated as an immediate cause of death, 3,4 and although it stands to reason that RA is uncommonly the proximate cause of death, RA-associated comorbidities may be implicated in many cases. Indeed, evidence supports an integral role for comorbid conditions in RA in terms of work-related disability and death. As opposed to a linear relation between arthritis patients as a whole and disability development, disability rises exponentially with the number of comorbidities.124,125 The number of comorbidities also serves as an independent risk factor for premature death in RA.29 Diminished survival in the face of therapeutic advances raises additional questions regarding these agents' role in the pathogenesis of RA-related comorbidities. Several major RA comorbidities have been identified. These conditions include cardiovascular disease (CVD), infection, malignancy, gastrointestinal (GI) disease, and osteoporosis leading to fracture. In this article, we review the impact of these selected comborbidities on RA outcome, discuss possible mechanisms for their association with RA (including the potential role of therapeutic agents), and summarize measures that may be used in the prevention and treatment of these conditions.

EXPLOR_STEP=$WICRI_ROOT/Sante/explor/ChloroquineV1/Data/Main/Exploration

HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 002282 | SxmlIndent | more

HfdSelect -h $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd -nk 002282 | SxmlIndent | more

{{Explor lien
   |wiki=    Sante
   |area=    ChloroquineV1
   |flux=    Main
   |étape=   Exploration
   |type=    RBID
   |clé=     ISTEX:B4FF149B086AF3F25D83A45109F37BC05C9AFE42
   |texte=   COMORBIDITY IN RHEUMATOID ARTHRITIS
}}