Zaccardelli Alessandra, Liu Xinyi, Ford Julia A, Cui Jing, Lu Bing, Chu Su H, Schur Peter H, Speyer Cameron B, Costenbader Karen H, Robinson William H, Sokolove Jeremy, Karlson Elizabeth W, Camargo Carlos A, Sparks Jeffrey A
Brigham and Women's Hospital, Boston, Massachusetts.
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2021 Apr;73(4):498-509. doi: 10.1002/acr.24140.
To investigate elevation of anti-citrullinated protein antibodies (ACPAs) before diagnosis of rheumatoid arthritis (RA) and risks for chronic obstructive pulmonary disease (COPD) or asthma.
We performed a matched cohort study nested within the Nurses' Health Studies among women who donated blood. Women with incident RA after blood draw (self-reported, then confirmed by medical records) were each matched to 3 controls by age, cohort, year, and menopausal factors. Pre-RA ACPA positivity was defined as >99th percentile of control distribution by a research assay or by cyclic citrullinated peptide in a subset. Incident COPD and asthma after index date (date of blood draw) were identified by questionnaires. Cox regression estimated hazard ratios (HRs) for incident COPD or asthma (in separate analyses) associated with pre-RA, pre-RA ACPA+, or pre-RA ACPA- phenotypes each compared to their matched non-RA controls.
We analyzed 283 women who were pre-RA and 842 controls; blood was donated a mean ± SD of 9.7 ± 5.8 years before RA diagnosis. Fifty-nine women (20.8%) were pre-RA ACPA+. There were 107 cases of incident COPD and 105 incident asthma cases during 21,489 person-years of follow-up. Pre-RA ACPA+ was associated with increased COPD risk (HR 3.04 [95% confidence interval (95% CI) 1.33-7.00]) after adjusting for covariates including smoking pack-years. Pre-RA ACPA+ had an HR for asthma of 1.74 (multivariable 95% CI 0.72-4.24), similar to the risk of asthma for pre-RA ACPA- (HR 1.65 [95% CI 1.11-2.46]).
Women with elevated ACPA before RA diagnosis had increased risk for developing COPD compared to controls. Women who later developed RA were more likely to develop asthma than controls, regardless of pre-RA ACPA status.
研究类风湿关节炎（RA）诊断前抗瓜氨酸化蛋白抗体（ACPA）水平升高情况以及慢性阻塞性肺疾病（COPD）或哮喘的发病风险。
我们在护士健康研究中针对献血女性开展了一项匹配队列研究。采血后发生RA的女性（自我报告，后经病历确认）按年龄、队列、年份和绝经因素与3名对照进行匹配。RA前ACPA阳性定义为通过研究检测或在一个亚组中通过环瓜氨酸肽检测，其水平高于对照分布的第99百分位数。通过问卷确定索引日期（采血日期）后发生的COPD和哮喘。Cox回归估计与RA前、RA前ACPA阳性或RA前ACPA阴性表型相关的COPD或哮喘发病风险比（HR），并分别与匹配的非RA对照进行比较。
我们分析了283名RA前女性和842名对照；在RA诊断前平均±标准差9.7±5.8年采集血液。59名女性（20.8%）为RA前ACPA阳性。在21489人年的随访期间，有107例COPD发病病例和105例哮喘发病病例。在调整包括吸烟包年数等协变量后，RA前ACPA阳性与COPD风险增加相关（HR 3.04 [95%置信区间（95%CI）1.33 - 7.00]）。RA前ACPA阳性的哮喘HR为1.74（多变量95%CI 0.72 - 4.24），与RA前ACPA阴性的哮喘风险相似（HR 1.65 [95%CI 1.11 - 2.46]）。
与对照相比，RA诊断前ACPA水平升高的女性患COPD的风险增加。无论RA前ACPA状态如何，后来发生RA的女性比对照更易患哮喘。
