Rheumatoid arthritis may increase the risk of developing chronic obstructive pulmonary disease (COPD). The findings indicate that greater vigilance may be needed to protect the respiratory health of individuals with chronic inflammatory conditions.
Research has demonstrated an association between COPD and inflammation, raising the question of whether prolonged inflammatory conditions such as rheumatoid arthritis predispose individuals to COPD. To investigate, a team led by Dr Diane Lacaille, of Arthritis Research Canada and the University of British Columbia, examined information on individuals in the province of British Columbia who were diagnosed with rheumatoid arthritis between 1996 and 2006, and compared it with information on matched individuals in the general population. The analysis included 24,625 patients with rheumatoid arthritis and 25,396 controls.
The investigators found that the incidence of COPD hospitalisation was greater in patients with rheumatoid arthritis than in the general population. After adjusting for potential confounding factors, individuals with rheumatoid arthritis had a 47% greater risk of needing to be hospitalised for COPD than controls. The increased risk remained significant after modelling for smoking and with varying COPD definitions.
"These findings are novel because it has only recently been recognised that inflammation plays a role in the development of COPD, and clinicians treating people with rheumatoid arthritis are not aware that their patients are at increased risk of developing COPD," said Lacaille. "Our results emphasise the need to control inflammation, and in fact to aim for complete eradication of inflammation through effective treatment of rheumatoid arthritis."
Lacaille added that clinicians and people living with rheumatoid arthritis should be vigilant in watching for early symptoms of COPD. "That way, appropriate tests can be administered to diagnose COPD early, at the onset of symptoms, so that effective treatments for COPD can be initiated before irreversible damage to the lungs occurs."
Such steps will improve long-term outcomes for patients and reduce the costs of COPD. The study also points to the need to address COPD risk factors – such as smoking – in people living with rheumatoid arthritis.
Abstract
Objective: Studies have demonstrated a link between COPD and inflammation, raising the question whether chronic inflammatory conditions, such as RA, predispose to COPD. Our objective was to evaluate the risk of incident COPD hospitalization in RA compared to the general population.
Methods: We studied a population-based incident RA cohort with matched general population controls, using administrative health data.. All incident RA cases in British Columbia (BC) who first met RA definition between 01/1996 and 12/2006 were selected using previously published criteria. General population controls were randomly selected, matched 1:1 to RA cases on birth year, sex, and index year. COPD outcome was defined as hospitalization with a primary COPD code.
Incidence rates, 95% Cis, and incidence rate ratios (IRR) were calculated for RA and controls. Multivariable Cox proportional hazard models (PHM) estimated the risk of COPD in RA compared to the general population after adjusting for potential confounders. Sensitivity analyses were performed to test the robustness of the results to the possible confounding effect of smoking, unavailable in administrative data, and to COPD outcome definitions.
Results: The cohorts included 24,625 RA individuals and 25,396 controls. The incidence of COPD hospitalization was greater in RA than controls [IRR (95%CI):1.58(1.34;1.87)]. After adjusting for potential confounders, RA cases had a 47% greater risk of COPD hospitalization than controls. The increased risk remained significant after modelling for smoking and with varying COPD definitions.
Conclusion: In our population-based cohort, individuals with RA had a 47% greater risk of COPD hospitalization compared to the general population.
Authors
Katherine McGuire, J Antonio Avina-Zubieta, John M Esdaile, Mohsen Sadatsafavi, Eric C Sayre, Michal Abrahamowicz, Diane Lacaille
[link url="https://www.sciencedaily.com/releases/2017/10/171019121830.htm"]Wiley material[/link]
[link url="http://onlinelibrary.wiley.com/doi/10.1002/acr.23410/abstract;jsessionid=6D46D5D0B5607ABF09D7371768183E84.f02t03"]Arthritis Care & Research abstract[/link]