Asthma, COPD linked with increased risk for RA in women
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Asthma and chronic obstructive pulmonary disease are each associated with an increased risk for rheumatoid arthritis, independent of smoking and other variables, according to data published in Arthritis & Rheumatology.
“Antibodies specific for rheumatoid arthritis, like rheumatoid factor and CCP, are generated at sites of airway inflammation,” Julia A. Ford, MD, of Brigham and Women’s Hospital and Harvard Medical School, told Healio Rheumatology. “However, whether diseases of chronic airway inflammation, like asthma and COPD, increase risk of developing RA isn’t totally clear.”
To analyze whether asthma or COPD were associated with RA, Ford and colleagues conducted a prospective, cohort study of 205,153 women in the Nurses’ Health Study (NHS). The researchers used data from both the 1988-2014 NHS and the 1991-2015 iteration (NHS 2). They validated self-reported and physician-diagnosed asthma and COPD through supplemental questionnaires. In all, 15,148 of the included participants had confirmed asthma and 3,573 had confirmed COPD.
Outcomes included incident RA, confirmed via a medical record review conducted by two rheumatologists. Covariates included smoking status and pack-years, and were identified through biennial questionnaires. The researchers estimated multivariable hazard ratios and confidence intervals using Cox regression.
According to the researchers, there were 1,060 cases of incidence RA during 4,384,471 personyears of followup in NHS and NHSII. After adjusting for smoking packyears and status, asthma was associated with an increased risk for RA (HR = 1.53; 95% CI, 1.24-1.88) compared with no asthma or COPD. This increased risk was also present among neversmokers only (HR = 1.53; 95% CI, 1.14-2.05). Further, COPD was also associated with an increased risk for RA (HR = 1.89; 95% CI, 1.31-2.75). This association was most pronounced among eversmokers older than 55 years (HR = 2.2; 95% CI, 1.38-3.51).
“We found that among women in the Nurses’ Health Studies, asthma was associated with a 50% increase in risk of subsequent rheumatoid arthritis compared to no asthma or COPD,” Ford said. “COPD was also associated with increased RA risk, particularly among women who were ever-smokers over the age of 55, who had double the risk of developing RA.”
“Both of these findings are independent of smoking status and duration or intensity,” she added. “Our findings should encourage physicians who care for patients with asthma or COPD to be vigilant about the increased RA risk in these patients and refer to rheumatology accordingly if symptoms of inflammatory arthritis develop.” – by Jason Laday
Disclosures: Ford reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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David A. McLain, MD, FACP, FACR
In this study, the researchers took the NHS and the NHS 2 databases and posed the question: Is chronic airway inflammation associated with rheumatoid arthritis, with or without smoking? As smoking is the strongest environmental risk factor for RA, it was unclear whether chronic airway inflammation was associated with RA without smoking. The researchers examined asthma and COPD, both associated with chronic airway inflammation.
According to the researchers, there was an impressive 50% increased risk of incident RA with asthma, independent of smoking and a 90% increased risk of incident RA with COPD, without smoking. This study reinforces the increasing interest of RA pathogenesis being related to the lung and airway mucosa.
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