2141 Buckley,etal:MortalityinPsA Personal non-commercial use only. The Journal of Rheumatology Copyright © 2010. All rights reserved. Mortality in Psoriatic Arthritis – A Single-center Study from the UK CAITRIONABUCKLEY,CHARLOTTECAVILL,GORDONTAYLOR,HAZELKAY,NICOLAWALDRON, ELEANOR KORENDOWYCH, and NEIL McHUGH ABSTRACT. Objective. To determine whether the mortality in a cohort of patients with psoriatic arthritis (PsA) fromasinglecenterintheUKissignificantlydifferentfromthegeneralUKpopulation. Methods. Patients who were entered onto the PsA database at the Royal National Hospital for Rheumatic Diseases, Bath, between 1985 and 2007 were included in this study. Information on patient deaths was collected retrospectively. The National Health Service (NHS) Strategic Tracing Servicewasusedtoestablishwhichpatientswerealiveandwhichhaddied.Dateandcauseofdeath were confirmed by death certificates from the Registry of Births, Marriages and Deaths. A stan- dardized mortality ratio (SMR) was calculated by matching the patient data to single-year, 5-year age-bandedEnglandandWalesdatafromtheOfficeofNationalStatistics. Results. In this cohort of 453 patients with PsA (232 men, 221 women), there were 37 deaths. Sixteen men and 21 women died. The SMR for the men was 67.87% (95% CI 38.79, 110.22), and forthewomen,97.01%(95%CI60.05,148.92)andtheoverallSMRforthePsAcohortwas81.82% (95% CI 57.61, 112.78). The leading causes of death in this cohort were cardiovascular disease (38%), diseases of the respiratory system (27%), and malignancy (14%). Conclusion. Theseresultssuggestthatmortalityinoursingle-centerPsAcohortisnotsignificantly different from the general UK population. No increased risk of death was observed in this cohort. (First ReleaseAugust 1 2010; J Rheumatol 2010;37:2141–4; doi:10.3899/jrheum.100034) KeyIndexingTerms: PSORIATICARTHRITIS MORTALITY From the Rheumatology Department, Royal National Hospital for Rheumatic Diseases; and the Research and Development Support Unit, University of Bath, Bath, UK. Partly supported by an unrestricted grant from Abbott Laboratories. C.E.Buckley,MB,BCh,BAO,MRCPI;C.R.Cavill,BSc,MSc; N.Waldron,MSc;E.Korendowych,MA,BM,BCh,MRCP,PhD; N.J.McHugh,MBChB,MD,FRCP,FRCPath,RoyalNationalHospital forRheumaticDiseases;G.J.Taylor,PhD;H.Kay,BScHons,Research and Development Support Unit; University of Bath. Address correspondence to Prof. N. McHugh, Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, BA1 1RL, UK. E-mail: triona18175@hotmail.com Accepted for publication May 20, 2010. Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associatedwithpsoriasiswithanestimatedincidencerateof up to 6.6 per 100,000/year 1,2,3,4 . While previously thought tobeabenignarthropathy,PsAisnowknowntobeassoci- ated with significant joint damage and disability 5,6,7,8 . In recent years, it has been firmly established that rheumatoid arthritis (RA) is associated with increased mor- tality, particularly due to cardiovascular disease 9,10 . Longterm outcome, including mortality, in other forms of inflammatory joint disease has been the subject of fewer studies.SuchstudiesinPsAhavethusfarshownconflicting results, with a community-based study showing no increase in mortality 2,3 while analysis of a hospital- based cohort estimated a combined standardized mortality ratio (SMR) for both men and women to be 1.62 11 . Cardiovascular dis- easewasthecommonestcauseofdeathinthelatterstudy. PatientswithPsAhavebeenfoundtohaveincreasedcar- diovascular risks 12 . PsA is associated with increased inci- dence of subclinical atherosclerosis 13,14 and an atherogenic lipid profile has been identified in active PsA 15 . There is increased prevalence of the metabolic syndrome in patients withpsoriasis,particularlyinthosewithmoderatetosevere skin disease 16 . Therefore, increased mortality in PsA, par- ticularlyduetocardiovasculardisease,wouldnotbeentire- ly unexpected. In an attempt to further clarify this issue, we examined whether mortality in our PsA cohort is significantly differ- ent from the general UK population. MATERIALS AND METHODS APsAclinicwasestablishedintheRoyalNationalHospitalforRheumatic Diseases (RNHRD), Bath, in 1985. The majority of the patients attending the clinic came from Bath and the surrounding area. Initially, most of the cohort (> 70%) was recruited from other rheumatology clinics at the RNHRDwhileaproportionofthemwerenewreferralsfromprimarycare. In later years the proportion referred directly from primary care increased (>70%).Asmallnumberofpatientswerereferreddirectlyfromdermatol- ogy(<20%).Patientsattendingtheclinicwereinvitedtobeenteredontoa PsA database. All patients who were entered onto the database between 1985 and 2007 were included in this study. Any patients entered onto the study needed to fulfil diagnostic criteria for PsA, which until 2007 were according to Moll and Wright 17 . From 2007 patients were required to ful- www.jrheum.org Downloaded on January 25, 2022 from