The rheumatic diseases not only bring pain, disability and poorer quality of life, but also a premature mortality which is often overlooked. Alongside mortality due to the direct complications of disease comes an increase in deaths related to specific therapies and indirect causes such as cancer and cardiovascular mortality. By comparing mortality and its causes in two of the most common inflammatory arthritides, rheumatoid arthritis and ankylosing spondylitis, common threads emerge which give us insight into the impact of chronic inflammatory disease and new directions for patient management.