Higher mortality in postmenopausal women with RA and anti-CCP antibodies

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Higher mortality in postmenopausal women with RA and anti-CCP antibodies New research shows mortality rates are two times higher in postmenopausal women with rheumatoid arthritis (RA) and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Findings published in the American College of Rheumatology (ACR) journal Arthritis & Rheumatism, soon to be called Arthritis & Rheumatology, indicate the higher mortality rates persisted after adjusting for age, positive rheumatoid factor, positive antinuclear antibodies (ANA) and disease modifying anti-rheumatic drug (DMARD) use.

According to the ACR, RA affects 1.3 million adults in the U.S. with 75% of those being women. Previous studies report that RA patients have mortality rates 1.5-fold higher than healthy controls. Medical evidence suggests that excess mortality is mainly caused by cardiovascular disease and is greater in groups with existing RA compared to those newly diagnosed. However, observational data indicate that methotrexate may reduce cardiovascular disease and mortality.

For the present study researchers from the University of Pittsburgh, led by Drs. Lewis Kuller and Larry Moreland, measured anti-CCP, rheumatoid factor and ANA in close to 10,000 women who self-reported RA as part of the Women's Health Initiative (WHI)—clinical trials and observational study of postmenopausal women, conducted by the National Institutes of Health (NIH). Participants included in the present research had a mean age of 64 years with 65% white, 25% black and 10% Hispanic.

Results show that anti-CCP was prevalent in 8.1% of the group, of whom 58% reported DMARD use during follow-up. Only 7.3% of the remaining 9,179 women with self-report RA, but negative anti-CCP, were using DMARDs. During the 10-year study period, 13% of women died—14% who self-reported RA at the start of the study and follow-up; 16% who reported RA at baseline; and 11% who reported RA at follow-up.

Further analysis determined that cardiovascular disease, including coronary heart disease and stroke, and cancer were the main cause of death among women with RA. Women with positive anti-CCP had a substantially higher mortality risk that was independent of DMARD use, including methotrexate, and modifiable risk factors (obesity, smoking) associated with mortality.

"Our study is the first large longitudinal study to evaluate anti-CCP, RF, risk factors and mortality," said Dr. Kuller. "Further investigation to determine specific causes of excess mortality, particularly among RA patients with positive anti-CCP, are needed."

### This study was funded by BAA NHLBI-WH-09-01 Contract No. HHSN268200960006C. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services (N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221).

This study is published in Arthritis & Rheumatism. Media wishing to receive a PDF of this article may contact sciencenewsroom@wiley.com.

Full citation: "Determinants of Mortality among Postmenopausal Women Who Report Rheumatoid Arthritis in the Women's Health Initiative." Lewis H. Kuller, Rachel H. Mackey, Brian T. Walitt, Kevin D. Deane, V. Michael Holers, William H. Robinson, Jeremy Sokolove, Yuefang Chang, Simin Liu, Christine G. Parks, Nicole C. Wright and Larry W. Moreland. . Arthritis & Rheumatism; Published Online: December 23, 2013 (DOI: 10.1002/art.38268).

URL Upon Publication: http://doi.wiley.com/10.1002/art.38268

About the Author: To arrange an interview with Dr. Kuller, please contact Cyndy McGrath with University of Pittsburg Graduate School of Public Health at mcgrathc3@upmc.edu.

About the Journal Arthritis & Rheumatism is an official journal of the American College of Rheumatology (ACR) and covers all aspects of inflammatory disease. The American College of Rheumatology is the professional organization whose members share a dedication to healing, preventing disability, and curing the more than 100 types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members include practicing physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. The journal is published by Wiley on behalf of the ACR. For more information, please visit http://wileyonlinelibrary.com/journal/art.

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