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Decrease in the number of deaths from secondary amyloidosis in patients with juvenile rheumatoid arthritis.

OBJECTIVE
The analysis of the mortality rate and causes of death of all Finnish patients with juvenile rheumatoid arthritis (JRA) in 1969-1979 and 1980-1990.


METHODS
Cases with JRA and deaths at the age of 24 years or younger were identified by using the nationwide register of persons entitled to free medication because of rheumatoid arthritis and allied diseases. Causes of death are based on autopsy in all but 4 of 47 cases.


RESULTS
There were 24 deaths during 1969-1979 and 23 during 1980-1990. The expected numbers of deaths were 8.9 and 9.5, giving a standardized mortality rate of 2.7 and 2.4, respectively. Secondary amyloidosis was the direct cause of death in 10 patients during the earlier period and in 4 patients during the later period.


CONCLUSIONS
The decrease in amyloidosis as a cause of death may be explained by an increased use of cytotoxic drug treatment for severe JRA in the early 1980s. Deaths from violence have increased.