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Asthma, Chronic Obstructive Pulmonary Disease, and Subsequent Risk for Incident Rheumatoid Arthritis Among Women: A Prospective Cohort Study
Author(s) -
Ford Julia A.,
Liu Xinyi,
Chu Su H.,
Lu Bing,
Cho Michael H.,
Silverman Edwin K.,
Costenbader Karen H.,
Camargo Carlos A.,
Sparks Jeffrey A.
Publication year - 2020
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.41194
Subject(s) - medicine , copd , asthma , hazard ratio , rheumatoid arthritis , prospective cohort study , proportional hazards model , cohort , cohort study , confidence interval
Objective Inflamed airways are hypothesized to contribute to rheumatoid arthritis ( RA ) pathogenesis due to RA ‐related autoantibody production, and smoking is the strongest environmental RA risk factor. However, the role of chronic airway diseases in RA development is unclear. We undertook this study to investigate whether asthma and chronic obstructive pulmonary disease ( COPD ) were each associated with RA . Methods We performed a prospective cohort study of 205,153 women in the Nurses’ Health Study ( NHS , 1988–2014) and NHSII (1991–2015). Exposures were self‐reported physician‐diagnosed asthma or COPD confirmed by validated supplemental questionnaires. The primary outcome was incident RA confirmed by medical record review by 2 rheumatologists. Covariates (including smoking pack‐years/status) were assessed via biennial questionnaires. Multivariable hazard ratios ( HR s) and 95% confidence intervals ( CI s) for RA were estimated using Cox regression. Results We identified 15,148 women with confirmed asthma, 3,573 women with confirmed COPD , and 1,060 incident RA cases during 4,384,471 person‐years (median 24.0 years/participant) of follow‐up in the NHS and NHSII . Asthma was associated with increased RA risk ( HR 1.53 [95% CI 1.24–1.88]) compared to no asthma/ COPD after adjustment for covariates, including smoking pack‐years/status. Asthma remained associated with increased RA risk when analyzing only never‐smokers ( HR 1.53 [95% CI 1.14–2.05]). COPD was also associated with increased RA risk ( HR 1.89 [95% CI 1.31–2.75]). The association of COPD with RA was most pronounced in the subgroup of ever‐smokers age >55 years ( HR 2.20 [95% CI 1.38–3.51]). Conclusion Asthma and COPD were each associated with increased risk of incident RA , independent of smoking status/intensity and other potential confounders. These results provide support for the hypothesis that chronic airway inflammation may be crucial in RA pathogenesis.