Increased Risk for COPD in Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) appear to be at increased risk for chronic obstructive pulmonary disease (COPD), according to a retrospective cohort study published in Arthritis Care & Research.¹

Researchers identified 24,625 patients with RA and 25,396 controls using administrative health data and compared the risk for incident COPD hospitalization in these populations.¹ Mean age at RA onset was 57.2, and patients with RA had greater comorbidity, glucocorticosteroid and cardiovascular drug use, and asthma prevalence.

Incident COPD hospitalizations were more frequent in the RA cohort than in the control group, with an incidence rate of 2.07 and 1.31 per 1000 patient-years, respectively.¹ 

Using a multivariable Cox proportional hazard model and after adjusting for potential confounders, it was calculated that patients with RA have a 47% greater risk of COPD hospitalization compared with controls. Similar results were found after modelling for smoking and when using varying definitions of COPD. However, a primary limitation of the study was the lack of data related to smoking status and history, which is a known risk factor for both RA and COPD.^2-3

The data in the present study are consistent with previous studies that demonstrate a correlation between COPD and inflammation.^4-8 Therefore, the investigators hypothesize that the chronic inflammation that occurs with RA is associated with incident COPD.¹ They concluded that “this has important clinical implications for clinicians and people living with RA, supporting the importance of controlling inflammation, of addressing COPD risk factors (eg, smoking), and of testing for COPD at the early onset of symptoms.”   

Reference

1. McGuire K, Avine-Zubieta JA, Esdaile JM, et al. Risk of incident chronic obstructive pulmonary disease (COPD) in rheumatoid arthritis: a population based cohort study [published online October 19, 2017]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23410
2. Sugiyama D, Nishimura K, Tamaki K, et al. Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis. 2010;69(1):70-81.
3. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007;370(9589):765-773.
4. Bieber V, Cohen AD, Freud T, Agmon-Levin N, Gertel S, Amital H. Autoimmune smoke and fire – coexisting rheumatoid arthritis and chronic obstructive pulmonary disease: a cross-sectional analysis. Immunologic Research. 2013;56(2-3):261-266.
5. Verstappen SM, Lunt M, Luben RN, et al. Demographic and disease-related predictors of abnormal lung function in patients with established inflammatory polyarthritis and a comparison with the general population. Ann Rheum Dis. 2013;72(9):1517-23.
6. Nannini C, Medina-Velasquez YF, Achenbach SJ, et al. Incidence and mortality of obstructive lung disease in rheumatoid arthritis: a population-based study. Arthritis Care Res (Hoboken). 2013;65(8):1243-50.
7. Ursum J, Nielen MM, Twisk JW, et al. Increased risk for chronic comorbid disorders in patients with inflammatory arthritis: a population based study. BMC Fam Pract. 2013;14:199.
8. Shen TC, Lin CL, Chen CH, et al. Increased risk of chronic obstructive pulmonary disease in patients with rheumatoid arthritis: a population-based cohort study. QJM. 2014;107(7):537-543.