Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Semin Arthritis Rheum. 2018 Apr;47(5):639-648. doi: 10.1016/j.semarthrit.2017.09.005. Epub 2017 Sep 18.
We investigated whether RA increases risk for chronic obstructive pulmonary disease (COPD) or asthma independent of factors occurring before RA onset or mediating these respiratory morbidities after diagnosis, such as cigarette smoking.
Within the prospective Nurses' Health Study (n = 121,701 women; 1976-2014), we identified an incident RA cohort and matched each woman with RA to 10 comparators without RA by age and year at index date of RA diagnosis, excluding women with COPD or asthma at baseline. Data were obtained through biennial questionnaires and medical records. We used marginal structural models to determine the independent effect of RA on incident COPD or asthma adjusting for confounders and time-varying mediators through inverse probability weighting.
We identified 843 women with RA, matched to 8,399 comparators without RA. Mean age was 59.8 years and mean follow-up after index date was 18.6 years (SD = 9.0) for women with RA, and 18.8 years (SD = 9.5) for comparators. We identified 68 (8.1%) incident COPD and 40 (4.7%) asthma cases among women with RA, and 459 (5.5%) COPD and 268 (3.2%) asthma cases among comparators. RA was associated with increased risk of COPD (HR = 1.52, 95% CI: 1.17-1.97) and asthma (HR = 1.55, 95% CI: 1.11-2.16) compared to comparators adjusted for the matching factors of age and calendar year at index date. After further adjustment for confounders and time-varying mediators occurring after index date, including smoking, RA was significantly associated with COPD (HR = 1.68, 95% CI: 1.36-2.07), but not asthma (HR = 1.11, 95% CI: 0.59-2.09) compared to non-RA comparators. Women with seropositive RA (HR = 1.60, 95% CI: 1.17-2.19) and seronegative RA (HR = 1.62, 95% CI: 1.09-2.40) had similar increased risk for COPD compared to non-RA comparators.
In this prospective cohort study, RA was associated with increased risk for incident COPD, independent of lifestyle confounders and mediators after diagnosis, including smoking.
我们旨在探究类风湿关节炎（RA）是否会增加慢性阻塞性肺疾病（COPD）或哮喘的发病风险，而这种风险是否独立于 RA 发病前出现的因素或诊断后导致这些呼吸系统疾病的中介因素（如吸烟）。
在这项前瞻性护士健康研究（Nurses' Health Study，NHS）中（n = 121701 名女性；1976 年至 2014 年），我们确定了一个新发 RA 队列，并通过年龄和 RA 诊断索引日期的年份，将每个患有 RA 的女性与 10 名无 RA 的女性相匹配，排除基线时有 COPD 或哮喘的女性。数据通过每两年一次的问卷调查和医疗记录获得。我们使用边缘结构模型，通过逆概率加权，确定 RA 对 COPD 或哮喘发病的独立影响，调整混杂因素和时间变化的中介因素。
我们确定了 843 名患有 RA 的女性，与 8399 名无 RA 的女性相匹配。RA 女性的平均年龄为 59.8 岁，自 RA 诊断索引日期后的平均随访时间为 18.6 年（标准差 [SD] = 9.0），而对照组为 18.8 年（SD = 9.5）。我们在 RA 女性中发现了 68 例（8.1%）新发 COPD 和 40 例（4.7%）哮喘病例，而对照组中有 459 例（5.5%）COPD 和 268 例（3.2%）哮喘病例。与对照组相比，RA 患者发生 COPD 的风险增加（HR = 1.52，95%CI：1.17-1.97）和哮喘（HR = 1.55，95%CI：1.11-2.16），调整了年龄和索引日期的日历年份等匹配因素。在进一步调整索引日期后出现的混杂因素和时间变化的中介因素，包括吸烟后，RA 与 COPD（HR = 1.68，95%CI：1.36-2.07）显著相关，但与哮喘（HR = 1.11，95%CI：0.59-2.09）无关，与非 RA 对照组相比。血清阳性 RA（HR = 1.60，95%CI：1.17-2.19）和血清阴性 RA（HR = 1.62，95%CI：1.09-2.40）患者与非 RA 对照组相比，发生 COPD 的风险也相似增加。
在这项前瞻性队列研究中，RA 与 COPD 的发病风险增加有关，这与诊断后包括吸烟在内的生活方式混杂因素和中介因素无关。
