Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Curr Rheumatol Rep. 2010 Oct;12(5):379-85. doi: 10.1007/s11926-010-0117-y.
Increased mortality in rheumatoid arthritis (RA) is widely recognized but not fully explained. Despite substantial improvements in management and growing knowledge of the determinants of increased mortality, evidence for reduction in mortality in RA has lagged behind. Indeed, most studies report no apparent reduction in mortality in RA. However, emerging evidence from some recent RA inception cohorts suggests no increased mortality, including cardiovascular mortality, but this awaits further confirmation. Although it is possible that recent advances in RA treatment may manifest in improvement of survival in the near future, other factors, including undertreated or unrecognized low-grade inflammation, comorbidities, and immunogenetic factors, may contribute to the excess mortality in RA and impede its improvement. In this review, we summarize the current knowledge of the rates and determinants of mortality in RA, identify and discuss potential explanations for excess mortality, and outline promising research avenues for targeting mortality in RA.
类风湿关节炎（RA）患者的死亡率升高是普遍公认的，但尚未完全阐明其原因。尽管在管理方面取得了重大进展，对导致死亡率升高的决定因素的了解也在不断增加，但 RA 患者死亡率降低的证据却一直滞后。事实上，大多数研究报告称 RA 患者的死亡率并没有明显降低。然而，一些最近的 RA 起始队列的新证据表明，RA 患者的死亡率并没有增加，包括心血管疾病死亡率，但这仍有待进一步证实。虽然 RA 治疗的近期进展可能会在不久的将来表现为生存率的提高，但其他因素，包括治疗不足或未被识别的低水平炎症、合并症和免疫遗传因素，可能会导致 RA 患者的死亡率过高，并阻碍其改善。在这篇综述中，我们总结了目前关于 RA 患者死亡率的发生率和决定因素的知识，确定并讨论了导致死亡率过高的潜在原因，并概述了针对 RA 患者死亡率的有前途的研究途径。
