Mortality in rheumatoid arthritis: do age and gender make a difference?

Rheumatoid arthritis (RA) is a significant cause of morbidity and mortality in both sexes. The extent to which age and gender are risk factors for increased mortality in RA, however, is still not clear. A review of existing literature on the effect of gender and age on mortality was performed. Twenty-five articles were identified from the world literature over the past decade. Ten articles representative of the existing literature in this field were analyzed in detail. Articles chosen as representative were characterized by peer-reviewed publication, large sample size, and geographic diversity of patient populations. One detailed analysis of prior literature also was included. The results failed to show a clear association between gender, age, and mortality in RA. Retrospective analyses of death certificates suggest an increased mortality among elderly women with RA. Longitudinal studies, however, suggest that both increasing age and male sex portend a worse prognosis in RA. A better understanding of mortality risk factors in RA, particularly with respect to age and gender, would require large randomized prospective trials conducted over long periods.