Moderate trauma fracture in rheumatoid arthritis associated with greater than expected excess mortality

   A moderate trauma fracture (fx) in rheumatoid arthritis (RA) is associated with a greater than expected excess mortality, investigators found. 

   Researchers from the Mayo Clinic in Rochester, Minnesota, studied a population-based inception cohort (age >/=18 years) who fulfilled 1987 American College of Rheumatology criteria for rheumatoid arthritis RA between 1955 and 2007, and an equal number of age- and sex-matched non-RA subjects from the same underlying population, who were followed until death or last available follow-up. All incident fractures were identified through a complete review (inpatient and outpatient) of medical records.

   In 1171 RA subjects, (822 women and 349 men), followed for 15,707 person-years, 440 had any moderate trauma fx, and 535 died over the available follow-up. In sex- and age-matched non-RA subjects, 374 had any moderate trauma fx and 441 died over 17,643 person-years follow-up. In RA subjects, a moderate trauma fx increased the risk for death (hazard ratio [HR] 2.2; 95% confidence interval [CI], 1.8 to 2.6). An increased risk for death was also observed in non-RA subjects following a moderate trauma fx (HR 1.5; 95% CI, 1.2 to 1.9) although this risk was significantly lower (P=0.04) than in RA. In RA subjects, any moderate trauma fracture remained a significant predictor of death even after adjusting for steroid use, being seropositive, or having nodules or erosions (HR 1.9; 95% CI, 1.6 to 2.3).

   According to the Mayo researchers, identifying characteristics or other comorbidities among those with RA who fracture may help explain this excess risk of death following fractures.