GLASGOW, Scotland — Respiratory diseases were the leading cause of death among men with rheumatoid arthritis (RA) according to research conducted in the southwest of England between 2015 and 2025.

Around 1 in 3 deaths over the 10-year period were due to respiratory causes while just 1 in 15 were due to cardiovascular disease (CVD), locum rheumatology consultant Melina Dissanayake, MD, from the Royal Cornwall Hospitals NHS Trust in Truro, England, reported at the British Society for Rheumatology (BSR) 2026 Annual Meeting.

“We all know that there’s increased mortality associated with rheumatoid arthritis, especially in males,” Dissanayake said. Historically, CVD has been the major cause of death from RA, particularly among men, she added, however, with improved cardiac care she believes “the causes of death in RA might have shifted over the past 2 decades.”

Dissanayake and colleague, therefore, conducted a prospective cohort study using data on 667 men with RA who had been treated within routine practice at their institution. The aim was to determine 10-year mortality among men with RA, and then second, to look at the specific cause of death in a subset of the men.

All participants were recruited between 2015 and 2016 and met 2010 ACR/EULAR classification criteria for RA. The mean age of the men at recruitment was 74 years. Three quarters were current or past smokers, and the mean pack-years smoked was 23.5.

Over a 10-year follow-up period, 247 men died, setting mortality at 37% or 3.7% per year.

Lung Disease Deaths Overtook Cardiac Causes

The researchers ascertained the cause of death in 200 men from hospital records or death certificates, showing 67 (33.5%) died from respiratory diseases and another 15 from lung cancer (7.5%), most commonly non-small cell lung cancer.

Other malignancies, such as prostate cancer, adrenal cancer, and bladder cancer accounted for a further 35 (17.5%) deaths. There were 12 (6.0%) deaths due to CVD, and the remaining 71 (35.5%) deaths were due to various causes, such as frailty, dementia, femoral fractures, and sepsis, among others.

They analyzed the causes of lung disease and its relation to heavy smoking and exposure to environmental vapors, gases, dusts, and fuels (VGDF). Heavy smoking was defined as more than 20 pack-years, meaning that the men had smoked at least one pack of 20 cigarettes daily for more than 20 years.

“Although there’s a positive trend toward mortality in heavy smokers, this is not statistically significant,” Dissanayake reported. Compared to no exposure, heavy smoking was associated with a 34% increase in the likelihood of death in the 10-year period (P = .076). The small sample size could have played a role in this finding being statistically nonsignificant.

However, when heavy smoking was considered in addition to environmental exposure, specifically more than three VGDFs, the odds of death rose by 67% (P = .020). This suggested that a number of cumulative inhalation insults were required to reach this mortality threshold.

Practice Implications

As respiratory diseases and lung cancer accounted for 41% of deaths altogether, “that’s something we have to keep in the back of our mind when we see patients in clinics,” Dissanayake said.

“I know we have limited time, but I think greater emphasis should be given to respiratory system examination in clinics,” she added, noting that chest auscultation and spirometry should be considered as part of the standard care of patients.

If possible, rheumatology and respiratory clinics should be joined together where it is feasible, she suggested, adding “smoking cessation programs and up-to-date vaccination should be strongly recommended.”

After her presentation, one delegate observed: “It’s really interesting to see how mortality has evolved,” and asked what proportion of the cohort had RA-associated lung disease such as interstitial lung disease (ILD) or bronchiectasis. Dissanayake responded that 54 (27%) of the men had ILD and the leading cause of death in those men was community-acquired pneumonia, followed by bronchiectasis and emphysema, and then lung cancer.

Consultant rheumatologist and senior author for the study, David Hutchinson, MD, Royal Cornwall Hospitals NHS Trust, told Medscape Medical News that Cornwall, where the study was conducted, is the second poorest area in Northern Europe. Many of the men in the area work in the construction, boat-building, or other service industries and, as such, were highly likely to have been exposed to environmental pollutants as a result of their profession or be frequent smokers. These factors could be contributing not only to the development of their RA but also to the development of respiratory disease.

Having lung disease can “massively” affect RA outcomes, Hutchinson said. “Sometimes you’re not fit enough to have the appropriate treatment. Sometimes the treatments are stopped and started because you’ve always got infection or chronic infection.”

Men with RA need to be asked about any respiratory symptoms, he said: “Some of these guys, their mobility is such that they don’t walk far enough to know that they’ve got the respiratory problem.”

Think, “are they really stopping smoking? They don’t always tell the truth. Are they properly vaccinated, and are they being seen by a respiratory physician if they’ve got significant fibrosis?” he advised.

“We should really be doing handheld spirometry before they come into clinic. If it’s abnormal, they should see a respiratory physician, because they’re in and out of hospital a lot of times.”

The study was independently supported. Dissanayake and Hutchinson had no conflicts of interest.

Sara Freeman is a medical journalist based in London, England.