Gergianaki Irini, Tsiligianni Ioanna
Health Planning Unit, Department of Social Medicine, School of Medicine, University of Crete Heraklion, Greece.
J Comorb. 2019 Jan 7;9:2235042X18820209. doi: 10.1177/2235042X18820209. eCollection 2019 Jan-Dec.
BACKGROUND: Although, both chronic obstructive pulmonary disease (COPD) and rheumatic diseases (RDs) are common, and each has significant impact on patients' overall health/quality of life, their co-occurrence has received little attention, while 15% of COPD remains undiagnosed in RDs. OBJECTIVE: To update the information regarding the comorbid state of RD/COPD (prevalence, incidence), to examine whether patients with RD have increased risk of developing COPD and vice versa, and what implications this comorbidity has on patients' outcomes (mortality, hospitalizations, exacerbations). METHODS: We performed a systematic literature review regarding the comorbidity of an RD (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), primary Sjogren syndrome disease (pSS), and systemic sclerosis (SSc)) with COPD. From 2803 reports retrieved, 33 articles were further screened. Finally, 27 articles were included. RESULTS: Robust evidence supports that COPD develops up to 68% more frequently in patients with RA, as compared to the general population. Similarly, COPD is increased in every other RD that was studied. Further, self-referred arthritis is more common in COPD patients versus non-COPD controls and a predictor of worst self-rated health status. Patients with inflammatory arthritis/COPD have increased mortality (threefold in RA-COPD, irrespectively of which is first diagnosed), hospitalizations, and emergency visits. CONCLUSION: COPD is more common in patients with RA, AS, PsA, SLE, pSS, and SSc; yet, the association, vice versa, warrants further investigation. Nevertheless, COPD/RDs coexistence has significant prognostic value for worst outcomes; therefore, awareness is required to track early identification, especially in primary care.
背景:虽然慢性阻塞性肺疾病(COPD)和风湿性疾病(RDs)都很常见,且各自对患者的整体健康/生活质量都有重大影响,但它们的共病情况很少受到关注,而在风湿性疾病患者中,15%的慢性阻塞性肺疾病仍未得到诊断。 目的:更新有关风湿性疾病/慢性阻塞性肺疾病共病状态(患病率、发病率)的信息,研究风湿性疾病患者患慢性阻塞性肺疾病的风险是否增加,反之亦然,以及这种共病对患者结局(死亡率、住院率、病情加重)有何影响。 方法:我们对一种风湿性疾病(类风湿关节炎(RA)、强直性脊柱炎(AS)、银屑病关节炎(PsA)、系统性红斑狼疮(SLE)、原发性干燥综合征(pSS)和系统性硬化症(SSc))与慢性阻塞性肺疾病的共病情况进行了系统的文献综述。从检索到的2803篇报告中,进一步筛选出33篇文章。最后,纳入了27篇文章。 结果:有力证据支持,与普通人群相比,类风湿关节炎患者患慢性阻塞性肺疾病的频率高出68%。同样,在其他所研究的风湿性疾病中,慢性阻塞性肺疾病的发病率也有所增加。此外,与非慢性阻塞性肺疾病对照组相比,慢性阻塞性肺疾病患者中自我报告的关节炎更为常见,且是自我健康状况评分最差的一个预测因素。患有炎症性关节炎/慢性阻塞性肺疾病的患者死亡率增加(类风湿关节炎合并慢性阻塞性肺疾病患者的死亡率增加三倍,与首先诊断出哪种疾病无关),住院率和急诊就诊次数也增加。 结论:慢性阻塞性肺疾病在类风湿关节炎、强直性脊柱炎、银屑病关节炎、系统性红斑狼疮、原发性干燥综合征和系统性硬化症患者中更为常见;然而,反之的关联情况仍需进一步研究。尽管如此,慢性阻塞性肺疾病/风湿性疾病共存对不良结局具有重要的预后价值;因此,需要提高认识以追踪早期诊断,尤其是在初级保健中。
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