Rheuma­toid arthri­tis in­creased risk of COPD

The Philippine Star - - OPINION - CHARLES C. CHANTE, MD

In­di­vid­u­als with rheuma­toid arthri­tis had an in­creased risk of hos­pi­tal­iza­tions for chronic ob­struc­tive pul­monary dis­ease, com­pared with the gen­eral pop­u­la­tion, in a Cana­dian ret­ro­spec­tive, pop­u­la­tion­based co­hort study.

The risk of COPD hos­pi­tal­iza­tions was 47 per­cent higher in in­di­vid­u­als with RA. “This find­ing em­pha­sizes the need to con­trol in­flam­ma­tion in rheuma­toid arthri­tis, not only to pre­vent joint dam­age, but also to pre­vent com­pli­ca­tions of sys­temic in­flam­ma­tion, in­clud­ing the devel­op­ment of co­mor­bidi­ties such as car­dio­vas­cu­lar diseases and COPD.

Sev­eral pre­vi­ous stud­ies have sug­gested a link be­tween COPD and in­flam­ma­tion. Ac­cord­ingly, they sought to eval­u­ate the risk of COPD hos­pi­tal­iza­tions in a co­hort of 24,625 in­di­vid­u­als with RA as com­pared with 25,396 gen­eral pop­u­la­tion con­trols ran­domly se­lected and matched based on age, sex, and in­dex year. Most sub­jects in the anal­y­sis were fe­male, and the mean age at on­set of RA was 57.2 years.

The in­ves­ti­ga­tors re­ported an in­creased in­ci­dence of COPD in in­di­vid­u­als with RA, com­pared with con­trols, based on an in­ci­dent rate ra­tio of 1.58 (95 per­cent con­fi­dence in­ter­val, 1.34-1.87) that dropped to 1.47 (95 per­cent CI, 1.24-1.74 ) af­ter ad­just­ment for po­ten­tial con­founders, in­clud­ing co­mor­bidi­ties and health ser­vices us­age at base­line. The over­all in­ci­dence rate for COPD was 2.07 per 1,000 pa­tient-years for RA pa­tients and 1.31 per 1,000 pa­tient-years for con­trols.

When the model was strat­i­fied based on sex, COPD hos­pi­tal­iza­tion risk was sig­nif­i­cantly in­creased in women (ad­justed haz­ard ra­tio, 1.61; 95 per­cent CI, 1.30-1.98), but not in men (ad­justed HR, 1.25;95 per­cent CI, 0.95-1.66), they said.

Data were not avail­able on smok­ing, the main COPD risk fac­tor, for the pa­tients in this study; how­ever, the in­creased risk of COPD hos­pi­tal­iza­tions in the RA group re­mained sig­nif­i­cant af­ter mod­el­ling for smok­ing, ac­cord­ing to in­ves­ti­ga­tors.

Com­bined, these re­sults have “no­table im­pli­ca­tions for the clin­i­cal care of RA and COPD, in­ves­ti­ga­tors said.

Both clin­i­cians and peo­ple liv­ing with RA “should be aware of the in­creased risk of de­vel­op­ing COPD and be vig­i­lant in watch­ing for early symp­toms of COPD, so that ap­pro­pri­ate di­ag­nos­tic tests can be ad­min­is­tered at the on­set of early symp­toms,” they wrote, “Early de­tec­tion of COPD is es­sen­tial so that ef­fec­tive treat­ments can be ini­ti­ated be­fore ir­re­versible dam­age to the lungs oc­curs, to im­prove long-term out­comes.”

These find­ings strengthen the con­clu­sions of two pre­vi­ous cross-sec­tional stud­ies show­ing an as­so­ci­a­tion be­tween RA and COPD preva­lence, ac­cord­ing to the in­ves­ti­ga­tors. In one study, RA pa­tients in Is­rael who were re­ceiv­ing dis­ease-mod­i­fy­ing anti-rheumatic drugs had dou­ble the preva­lence of COPD, com­pared with gen­eral pop­u­la­tion con­trols, ac­cord­ing to au­thors of that study. Sim­i­larly, UK in­ves­ti­ga­tors com­pared 421 RA pa­tients against con­trols and re­ported a twofold in­crease in ob­struc­tive pat­tern on screen­ing spirom­e­try in the RA group.

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