Sihvonen S et al. (2006) Mortality in patients with rheumatoid arthritis treated with low-dose oral glucocorticoids. A population-based cohort study. J Rheumatol 33: 1740–1746

Patients with rheumatoid arthritis (RA) have increased mortality compared with the general population. The excess mortality of these patients has been attributed to several factors; however, the contribution of glucocorticoid use remains poorly defined.

In their population-based study, Sihvonen and colleagues reviewed the medical records of 604 patients with RA. Data on these patients' general state of health, comorbidities, severity of RA, and RA treatments including oral glucocorticoid therapy were collected between 1988 and 1999. No information was obtained on intra-articular glucocorticoid therapy. Patients were assigned to groups according to their oral glucocorticoid use: minimal users (n = 209) had never taken glucocorticoids or had used them for >1 month, medium-term users (n = 276) had taken glucocorticoids for between 1 month and 10 years, and long-term users (n = 119) had taken glucocorticoids for >10 years.

In total, 160 patients had died by 1999: 48 (23%) minimal users; 57 (21%) medium-term users; and 53 (45%) long-term users. The main cause of death was cardiovascular disease in all groups. Infections and intestinal perforations due to amyloidosis were more frequent in long-term glucocorticoid users than in patients from the other groups, and lymphomas were most common in medium-term and long-term glucocorticoid users.

The authors conclude that patients with RA who take oral glucocorticoids for >10 years have an increased risk of mortality compared with those who take glucocorticoids for <10 years or have never taken glucocorticoids.