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Rheumatoid arthritis and changes on spirometry by smoking status in two prospective longitudinal cohorts
Keigo Hayashi1, Gregory C McDermott1,2, Pierre-Antoine Juge1
1Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA.
RMD Open
|June 17, 2024
Summary
Rheumatoid arthritis (RA) patients who smoke showed slower lung function decline than non-RA comparators. However, never-smokers with RA experienced a faster decline in lung function.
Area of Science:
- Pulmonary Medicine
- Rheumatology
- Epidemiology
Background:
- Rheumatoid arthritis (RA) is a systemic autoimmune disease that can affect multiple organs, including the lungs.
- Lung disease is a common comorbidity in RA patients, and its impact on lung function over time is not fully understood.
Purpose of the Study:
- To compare longitudinal changes in spirometric measures between patients with rheumatoid arthritis (RA) and non-RA comparators.
- To investigate the influence of smoking status and obstructive patterns on lung function decline in RA patients.
Main Methods:
- Analysis of longitudinal data from the UK Biobank and COPDGene cohorts.
- Spirometry (FEV1% and FVC%) measured at baseline and follow-up (5-7 years).
- Multivariable linear regression comparing RA patients and non-RA comparators, stratified by smoking status and obstructive pattern (FEV1/FVC <0.7).
Main Results:
- In never-smokers without obstructive patterns, RA was linked to greater FEV1% decline (β=-0.49, p=0.04).
- In ever-smokers with RA (≥10 pack-years), there was significantly less FEV1% decline compared to non-RA comparators (β=0.50, p=0.02), particularly in those with obstructive patterns (β=1.12, p=0.01).
- Similar trends were observed for FEV1/FVC decline; no significant difference in FVC% change was found.
Conclusions:
- Smokers with RA, especially those with obstructive patterns, exhibit slower lung function decline than non-RA comparators.
- Never-smokers with RA show accelerated lung function decline compared to non-RA comparators.
- Further research is needed to explore treatments and the pathogenesis of obstructive lung diseases in RA patients who smoke.
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