Aim
Rheumatoid Arthritis (RA) has been associated with elevated post-fracture mortality, potentially due to its associated comorbidities. This study aimed to identify specific comorbidities driving post-fracture mortality in RA patients.
Methods
This case-control matched study was conducted using the West Australian Rheumatic Disease Epidemiological Registry (WARDER). 1075 RA patients with a potential fragility fracture presenting to WA hospitals between 1996 and 2010 were matched to 1156 rheumatic disease-free controls using age, year of first fracture, Accessibility Remoteness Index of Australia, sex, and the rheumatic disease version of the Charlson Comorbidity Index (CCI). Patients were followed for up to five years with COD categorised by system according to the International Classification of Disease.
Findings
RA was associated with significantly reduced survival post-fracture due to cardiovascular disease (CVD; HR 1.35, 95% CI 1.13–1.61, p=0.001) and infectious diseases (ID; HR 1.58, 95% CI 1.02–2.45, p=0.04). CVD mortality risk were elevated in patients with prior myocardial infarction (HR 1.46, 95% CI 1.09–1.97, p=0.01), while ID-mortality was increased in remote patients (HR 2.00, 95% CI 1.10–3.66, p=0.02) with chronic renal disease (HR 2.82, 95% CI 1.61–4.96, p<0.001).
Conclusion
RA patients experiencing fractures face a heightened risk of death from CVD and ID. Implementing strategies such as more intensive CVD surveillance in RA patients with a history of myocardial infarction or consideration of antibiotic prophylaxis in RA patients from remote regions with a history of chronic renal disease could reduce post-fracture mortality.