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Microscopic colitis and risk of incident rheumatoid arthritis: A nationwide population-based matched cohort study
David Bergman1, Bjorn Roelstraete1, Jiangwei Sun1
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Background:
Microscopic colitis (MC) has been linked to several autoimmune conditions. Results from previous studies on the association with rheumatoid arthritis (RA) have been inconsistent.
Aim:
To assess the risk of future RA in MC.
Methods:
We conducted a nationwide matched cohort study in Sweden of 8179 patients with biopsy-verified MC (diagnosed in 2007-2017), 36,400 matched reference individuals and 8202 siblings without MC, with follow-up until 2021. Information on MC was obtained from all of Sweden's regional pathology registers (n = 28) through the ESPRESSO cohort. Data on incident RA were collected from the National Patient Register. Using Cox regression, we calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).
Results:
During a median follow-up of 9.1 years (interquartile range = 6.7-11.7), 73 MC patients and 183 reference individuals from the general population were diagnosed with RA (99 vs. 55 events per 100,000 person-years), equivalent to one extra case of RA in 226 patients with MC followed for 10 years. These rates corresponded to an aHR of 1.83 (95% CI = 1.39-2.41). The aHR was highest during the first year of follow-up (2.31 [95% CI = 1.08-4.97]) and remained significantly elevated up to 5 years after MC diagnosis (aHR 2.16; 95% CI = 1.42-3.30). Compared to siblings, without MC, the aHR was 2.04 (95% CI = 1.18-3.56).
Conclusion:
Patients with MC are at a nearly two-fold risk of developing RA compared to the general population. Knowledge of this increased risk may expedite evaluation for RA in patients with MC presenting with joint symptoms and/or arthralgia, thus preventing delay until RA diagnosis.
Insights
Patients with microscopic colitis (MC) have a nearly doubled risk of developing rheumatoid arthritis (RA). Early evaluation of joint symptoms in MC patients can help diagnose RA sooner.
Area of Science:
- Gastroenterology
- Rheumatology
- Epidemiology
Background:
- Microscopic colitis (MC) is associated with autoimmune conditions, but its link to rheumatoid arthritis (RA) requires further clarification.
- Previous studies on the association between MC and RA have yielded inconsistent results.
Purpose of the Study:
- To investigate the risk of developing rheumatoid arthritis (RA) in patients diagnosed with microscopic colitis (MC).
Main Methods:
- A nationwide matched cohort study in Sweden included 8179 MC patients and matched controls.
- Data were collected from pathology and national patient registers, with follow-up until 2021.
- Cox regression analysis was used to calculate adjusted hazard ratios (aHRs) and confidence intervals (CIs).
Main Results:
- Patients with MC showed a nearly two-fold increased risk of RA (aHR 1.83).
- The elevated risk was most pronounced within the first year post-diagnosis and remained significant up to five years.
- Compared to siblings, MC patients had a 2.04-fold increased risk of RA.
Conclusions:
- Microscopic colitis patients face a significantly higher risk of developing rheumatoid arthritis.
- Prompt assessment of joint symptoms in MC patients is crucial for timely RA diagnosis and management.
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