{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:14:38Z","timestamp":1792102478786,"version":"4.4.0"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["H30-menneki-shitei-002"],"award-info":[{"award-number":["H30-menneki-shitei-002"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","award":["22FE0201"],"award-info":[{"award-number":["22FE0201"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020830","name":"Ayumi Pharmaceutical","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100020830","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,22]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the standardized mortality ratio (SMR), causes of death, and mortality risk factors in Japanese patients with rheumatoid arthritis (RA) between 2007 and 2021, representing the biological disease-modifying antirheumatic drug (bDMARD) era.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed Japanese patients in the Institute of Rheumatology, Rheumatoid Arthritis cohort. The SMR was calculated using the Japanese General Population Life Table. Multiple imputation methods were used for sensitivity analysis of lost-to-follow-up cases. Risk factors were analysed using a time-dependent Cox proportional hazards model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 10,613 patients with RA, 915 deaths occurred for 99,364.8 patient-years. Major causes of death were malignancy (27.8%), respiratory disease (22.3%), and cardiovascular disease (16.3%). The SMR varied based on lost-to-follow-up assumptions: 0.92 [95% confidence interval (CI): 0.86\u20130.98] assuming all survived, 1.57 (95% CI: 1.47\u20131.68) assuming lost cases had equal mortality to followed cases, and 1.68 (95% CI: 1.58\u20131.79) assuming 1.65 times higher mortality than followed cases, respectively. Time-dependent analysis revealed protective associations with methotrexate (MTX) and bDMARDs, while even low-dose glucocorticoids showed increased mortality risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Japanese patients with RA show excess mortality despite bDMARD-era treatments. MTX and bDMARDs were protective, while glucocorticoids increased mortality risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/mr\/roaf074","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:53:34Z","timestamp":1753876414000},"page":"15-24","source":"Crossref","is-referenced-by-count":2,"title":["Mortality and risk factors in Japanese patients with rheumatoid arthritis: a 14-year observation of the IORRA cohort"],"prefix":"10.1093","volume":"36","author":[{"given":"Naohiro","family":"Sugitani","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Tokyo Women\u2019s Medical University School of Medicine , Tokyo ,","place":["Japan"]},{"name":"Center for Rheumatic Diseases, Mie University Hospital , Mie ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2850-326X","authenticated-orcid":false,"given":"Eiichi","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Tokyo Women\u2019s Medical University School of Medicine , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eisuke","family":"Inoue","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Tokyo Women\u2019s Medical University School of Medicine , Tokyo ,","place":["Japan"]},{"name":"Research Administration Center, Showa University , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eri","family":"Sugano","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Tokyo Women\u2019s Medical University School of Medicine , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moeko","family":"Ochiai","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Tokyo Women\u2019s Medical University School of Medicine , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsunori","family":"Ikari","sequence":"additional","affiliation":[{"name":"Section of Surgery for Inflammatory Joint Diseases, Department of Orthopedic Surgery, Tokyo Women\u2019s Medical University School of Medicine , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayako","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Center for Rheumatic Diseases, Mie University Hospital , Mie ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisashi","family":"Yamanaka","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Tokyo Women\u2019s Medical University School of Medicine , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayoshi","family":"Harigai","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Tokyo Women\u2019s Medical University School of Medicine , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"2026021908164955500_ref1","doi-asserted-by":"crossref","first-page":"2023","DOI":"10.1016\/S0140-6736(16)30173-8","article-title":"Rheumatoid 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A primary care cohort study using data from Clinical Practice Research Datalink","volume":"57","author":"Abhishek","year":"2018","journal-title":"Rheumatology (Oxford)"},{"key":"2026021908164955500_ref21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/14397595.2019.1660028","article-title":"A large observational cohort study of rheumatoid arthritis, IORRA: providing context for today\u2019s treatment options","volume":"30","author":"Yamanaka","year":"2020","journal-title":"Mod Rheumatol"},{"key":"2026021908164955500_ref22","article-title":"e-Stat. 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