Rheumatoid arthritis and mortality. A longitudinal study in Pima Indian

National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona.
Arthritis & Rheumatology (Impact Factor: 7.76). 09/1993; 36(8):1045-53. DOI: 10.1002/art.1780360804
Source: PubMed


To determine the effect of rheumatoid arthritis (RA) on mortality rates.
Longitudinal analyses of data from a cohort of Pima Indians from the Gila River Indian Community in Arizona, who were followed up during the period February 1965 through December 1989.
Among 2,979 study subjects aged > or = 25 years, there were 858 deaths, 79 of which occurred in subjects with RA (36 men, 43 women). Age- and sex-adjusted mortality rates were slightly higher in subjects with RA than in those without (mortality rate ratio 1.28, 95% confidence interval [95% CI] 1.01-1.62). Among those with RA, mortality rates were higher in older subjects (mortality rate ratio 1.51 per 10-year increase in age, 95% CI 1.22-1.88), in male subjects (mortality rate ratio 2.23, 95% CI 1.44-3.45, adjusted for age), and in subjects with proteinuria (mortality rate ratio 1.88, 95% CI 1.02-3.46, adjusted for age and sex). Mortality rate ratios for these risk factors were similar in subjects without RA. In addition, among subjects with RA, rheumatoid factor (RF) positivity was predictive of death (mortality rate ratio 1.94, 95% CI 1.10-3.43), and the excess mortality was found primarily among subjects who were seropositive. The death rate from cardiovascular disease (mortality rate ratio 1.77, 95% CI 1.10-2.84) and from liver cirrhosis or other alcohol-related disease (mortality rate ratio 2.52, 95% CI 1.06-6.01) was increased in persons with RA.
The results of this population-based study suggest that although the risk of mortality in subjects with RA is significantly higher than in those without RA, the risk ratio is in the lower range of that described previously in studies of clinic-based cohorts. RF positivity as a predictor of early death among subjects with RA indicates that the immunologic processes in seropositive RA may contribute to the events that eventually lead to early death.

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    • "RF positivity has also been reported in the healthy population [31] [32] [33], and up to 4% of young Caucasians may be RF positive, with a similar distribution between the two genders. It is thought that genetic and environmental factors are responsible for the worldwide variability in distribution of RFs: for example, their highest prevalence (up to 30%) has been observed in North American Indians tribes [34] [35] [36]. The RFs found in healthy subjects are different from those present in RA patients as their titres are low/moderate and they are likely to be produced by CD5-expressing B cells as lowaffinity , poly-reactive IgMs without any signs of maturation affinity [31]. "
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    ABSTRACT: Rheumatoid factors are antibodies directed against the Fc region of immunoglobulin G. First detected in patients with rheumatoid arthritis 70 years ago, they can also be found in patients with other autoimmune and nonautoimmune conditions, as well as in healthy subjects. Rheumatoid factors form part of the workup for the differential diagnosis of arthropathies. In clinical practice, it is recommended to measure anti-cyclic citrullinated peptide antibodies and rheumatoid factors together because anti-cyclic citrullinated peptide antibodies alone are only moderately sensitive, and the combination of the two markers improves diagnostic accuracy, especially in the case of early rheumatoid arthritis. Furthermore, different rheumatoid factor isotypes alone or in combination can be helpful when managing rheumatoid arthritis patients, from the time of diagnosis until deciding on the choice of therapeutic strategy.
    Disease markers 11/2013; 35(6):727-734. DOI:10.1155/2013/726598 · 1.56 Impact Factor
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    • "The risk of CVD is also increased in RA, although not as strikingly as in SLE [32-35]. The risk varies in different studies, which could depend on the study populations chosen, age and other factors, including secular trends for RA per se. "
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    ABSTRACT: During recent years atherosclerosis, the major cause of cardiovascular disease (CVD), has been recognised as a chronic inflammatory condition in which rupture of atherosclerotic lesions appears to play a major role. The risk of CVD is raised in many rheumatic diseases. This risk is high in systemic lupus erythematosus - as much as a 50-times increase among middle-aged women has been reported. Studies on CVD and atherosclerosis in rheumatic disease could thus provide interesting information about CVD and atherosclerosis in addition to being an important clinical problem. A combination of traditional and nontraditional risk factors accounts for the increased risk of CVD and atherosclerosis in rheumatic disease. One interesting possibility is that atherosclerotic lesions in rheumatic disease are more prone to rupture than normal atherosclerotic lesions. It is also likely that increased risk of thrombosis may play an important role, not least in systemic lupus erythematosus. Further, it is not clear whether an increased risk of CVD is a general feature of rheumatic disease, or whether this only occurs among subgroups of patients. It should be emphasised that there is an apparent lack of treatment studies where CVD in rheumatic disease is the end point. Control of disease activity and of traditional risk factors, however, appears to be well founded in relation to CVD in rheumatic disease. Further studies are needed to determine the exact role of lipid-lowering drugs as statins. Hopefully novel therapies can be developed that target the causes of the inflammation in atherosclerotic lesions both in rheumatic patients and in the general population.
    Arthritis research & therapy 06/2011; 13(3):225. DOI:10.1186/ar3326 · 3.75 Impact Factor
    • "In addition, Galvão et al. reported twenty cases of CD in North of Brazil in a mixed population (Europeans and local Indians)[9]. On the other hand, high prevalence and more severe disease, as well as increased comorbidity and mortality rates, were demonstrated in different Indian populations for other autoimmune diseases[1011], such as rheumatoid arthritis[101213], systemic lupus erythematosus[1415], primary biliary cirrhosis[16–18], systemic sclerosis[1920] and type I diabetes[21], amongst others. Both genetic and environmental components have been considered as the main factors influencing the development of these autoimmune disorders in native Indians. "
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    ABSTRACT: Celiac disease has been described in populations from around the world, with recent data emphasizing the occurrence of the disease in ethnic minorities. There are only a few studies evaluating celiac disease in native Indians. This study aimed to screen the anti-endomysial antibody (IgA-EmA) in Kaingang and Guarani Indians from southern Brazil, in order to establish a clinical serological evaluation of celiac disease in these individuals. Serum samples from 321 individuals (125 male and 196 female; 4-86 years old) from Mangueirinha Indigenous Reserve, State of Parana, Brazil, and 180 non-Indigenous healthy individuals (62 male and 118 female; 2-81 years old) were analysed to the presence of anti-endomysial antibody class IgA by indirect immunofluorescence assay. Amongst the Indians, 158 were Kaingang, 98 Guarani and 65 of mixed race. Indians presenting complaints of diarrhea (N=12) were also evaluated to the IgG class of anti-endomisyal antibody. None of the individuals showed positive results either to IgA or IgG anti-endomysial antibodies. Although the results indicate an absence of celiac disease in Kaingang and Guarani Indians, the authors call attention to the importance of following up indigenous children or adults presenting gastrointestinal complaints or other symptoms related to the disease. Consideration should be given to the genetic background of these individuals, allied to the inter ethnic marriages and the changing habits or occupational activities, that have gradually introduced diseases previously not described in indigenous populations.
    North American Journal of Medical Sciences 03/2010; 2(3):138-42. DOI:10.4297/najms.2010.3138
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