哮喘，慢性阻塞性肺疾病和随后的女性类风湿关节炎事件风险：一项前瞻性队列研究
2021/11/24
摘要
目的：假设炎症气道由于RA相关的自身抗体产生而导致类风湿性关节炎（RA）发病，并且吸烟是最强的环境RA危险因素。然而，慢性气道疾病在RA发展中的作用尚不清楚。我们进行了这项研究，以调查哮喘和慢性阻塞性肺疾病（COPD）是否都与RA相关。
方法：我们对护士健康研究（NHS,205，153-1988）和NHSII（2014-1991）中的2015名女性进行了前瞻性队列研究。暴露是经验证的补充问卷证实的自我报告的医生诊断的哮喘和COPD。主要结局是由2名风湿病专家的病历审查证实的偶发性RA。通过两年一次的调查问卷评估协变量（包括吸烟包-年/状态）。使用Cox回归估计RA的多变量风险比（HRs）和95%置信区间（CI）。
结果：我们在15148人-年（平均3573年/参与者）中确定了1060例确诊哮喘女性，4384471例确诊COPD女性和24例RA时间病历NHS和NHSII的随访。在校正协变量（包括吸烟包-年/状态）后，与无哮喘/COPD相比，哮喘与RA风险增加有关（HR 1.53[95%CI 1.24-1.88]）。当仅分析从不吸烟者时，哮喘仍然与RA风险增加相关（HR 1.53[95%CI 1.14-2.05]）。COPD也与RA风险增加相关（HR 1.89[95%CI 1.31-2.75]）。COPD与RA的相关性在年龄＞55岁的吸烟者亚组中最明显（HR 2.20[95%CI 1.38-3.51]）。
结论：哮喘和COPD均与RA事件风险增加相关，独立于吸烟状态/强度和其他潜在混杂因素。这些结果为慢性气道炎症可能在RA发病机制中至关重要的假说提供了支持。
Asthma, Chronic Obstructive Pulmonary Disease, and Subsequent Risk for Incident Rheumatoid Arthritis Among Women: A Prospective Cohort Study
Julia A Ford , Xinyi Liu , Su H Chu, Bing Lu , Michael H Cho, Edwin K Silverman, Karen H Costenbader, Carlos A Camargo Jr , Jeffrey A Sparks
Abstract
Objective: Inflamed airways are hypothesized to contribute to rheumatoid arthritis (RA) pathogenesis due to RA-related autoantibody production, and smoking is the strongest environmental RA risk factor. However, the role of chronic airway diseases in RA development is unclear. We undertook this study to investigate whether asthma and chronic obstructive pulmonary disease (COPD) were each associated with RA.
Methods: We performed a prospective cohort study of 205,153 women in the Nurses' Health Study (NHS, 1988-2014) and NHSII (1991-2015). Exposures were self-reported physician-diagnosed asthma or COPD confirmed by validated supplemental questionnaires. The primary outcome was incident RA confirmed by medical record review by 2 rheumatologists. Covariates (including smoking pack-years/status) were assessed via biennial questionnaires. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for RA were estimated using Cox regression.
Results: We identified 15,148 women with confirmed asthma, 3,573 women with confirmed COPD, and 1,060 incident RA cases during 4,384,471 person-years (median 24.0 years/participant) of follow-up in the NHS and NHSII. Asthma was associated with increased RA risk (HR 1.53 [95% CI 1.24-1.88]) compared to no asthma/COPD after adjustment for covariates, including smoking pack-years/status. Asthma remained associated with increased RA risk when analyzing only never-smokers (HR 1.53 [95% CI 1.14-2.05]). COPD was also associated with increased RA risk (HR 1.89 [95% CI 1.31-2.75]). The association of COPD with RA was most pronounced in the subgroup of ever-smokers age >55 years (HR 2.20 [95% CI 1.38-3.51]).
Conclusion: Asthma and COPD were each associated with increased risk of incident RA, independent of smoking status/intensity and other potential confounders. These results provide support for the hypothesis that chronic airway inflammation may be crucial in RA pathogenesis.
目的：假设炎症气道由于RA相关的自身抗体产生而导致类风湿性关节炎（RA）发病，并且吸烟是最强的环境RA危险因素。然而，慢性气道疾病在RA发展中的作用尚不清楚。我们进行了这项研究，以调查哮喘和慢性阻塞性肺疾病（COPD）是否都与RA相关。
方法：我们对护士健康研究（NHS,205，153-1988）和NHSII（2014-1991）中的2015名女性进行了前瞻性队列研究。暴露是经验证的补充问卷证实的自我报告的医生诊断的哮喘和COPD。主要结局是由2名风湿病专家的病历审查证实的偶发性RA。通过两年一次的调查问卷评估协变量（包括吸烟包-年/状态）。使用Cox回归估计RA的多变量风险比（HRs）和95%置信区间（CI）。
结果：我们在15148人-年（平均3573年/参与者）中确定了1060例确诊哮喘女性，4384471例确诊COPD女性和24例RA时间病历NHS和NHSII的随访。在校正协变量（包括吸烟包-年/状态）后，与无哮喘/COPD相比，哮喘与RA风险增加有关（HR 1.53[95%CI 1.24-1.88]）。当仅分析从不吸烟者时，哮喘仍然与RA风险增加相关（HR 1.53[95%CI 1.14-2.05]）。COPD也与RA风险增加相关（HR 1.89[95%CI 1.31-2.75]）。COPD与RA的相关性在年龄＞55岁的吸烟者亚组中最明显（HR 2.20[95%CI 1.38-3.51]）。
结论：哮喘和COPD均与RA事件风险增加相关，独立于吸烟状态/强度和其他潜在混杂因素。这些结果为慢性气道炎症可能在RA发病机制中至关重要的假说提供了支持。
(中日友好医院呼吸与危重症医学科 张清 摘译 林江涛 审校)
(Arthritis Rheumatol. 2020 May;72(5):704-713. doi: 10.1002/art.41194.)
(Arthritis Rheumatol. 2020 May;72(5):704-713. doi: 10.1002/art.41194.)
Asthma, Chronic Obstructive Pulmonary Disease, and Subsequent Risk for Incident Rheumatoid Arthritis Among Women: A Prospective Cohort Study
Julia A Ford , Xinyi Liu , Su H Chu, Bing Lu , Michael H Cho, Edwin K Silverman, Karen H Costenbader, Carlos A Camargo Jr , Jeffrey A Sparks
Abstract
Objective: Inflamed airways are hypothesized to contribute to rheumatoid arthritis (RA) pathogenesis due to RA-related autoantibody production, and smoking is the strongest environmental RA risk factor. However, the role of chronic airway diseases in RA development is unclear. We undertook this study to investigate whether asthma and chronic obstructive pulmonary disease (COPD) were each associated with RA.
Methods: We performed a prospective cohort study of 205,153 women in the Nurses' Health Study (NHS, 1988-2014) and NHSII (1991-2015). Exposures were self-reported physician-diagnosed asthma or COPD confirmed by validated supplemental questionnaires. The primary outcome was incident RA confirmed by medical record review by 2 rheumatologists. Covariates (including smoking pack-years/status) were assessed via biennial questionnaires. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for RA were estimated using Cox regression.
Results: We identified 15,148 women with confirmed asthma, 3,573 women with confirmed COPD, and 1,060 incident RA cases during 4,384,471 person-years (median 24.0 years/participant) of follow-up in the NHS and NHSII. Asthma was associated with increased RA risk (HR 1.53 [95% CI 1.24-1.88]) compared to no asthma/COPD after adjustment for covariates, including smoking pack-years/status. Asthma remained associated with increased RA risk when analyzing only never-smokers (HR 1.53 [95% CI 1.14-2.05]). COPD was also associated with increased RA risk (HR 1.89 [95% CI 1.31-2.75]). The association of COPD with RA was most pronounced in the subgroup of ever-smokers age >55 years (HR 2.20 [95% CI 1.38-3.51]).
Conclusion: Asthma and COPD were each associated with increased risk of incident RA, independent of smoking status/intensity and other potential confounders. These results provide support for the hypothesis that chronic airway inflammation may be crucial in RA pathogenesis.
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