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Increased Risk of COPD in ACPA+ Pre-RA Patients

Apr 21, 2021 3:20 pm

The lung and its pathology is uniquely tied to rheumatoid arthritis (RA) and its pathogenesis.  A new study shows that elevation of anti–citrullinated protein antibodies (ACPAs) before diagnosis of RA increases the risk of developing chronic obstructive pulmonary disease (COPD) and/or asthma.

This finding is important as there are other studies showing:

  • Smoking increases the risk of developing RA and having worse disease activity
  • Having COPD increases the risk of developing RA
  • RA patients have a greater risk of developing COPD
  • 6-10% of RA patients also have COPD and these patients have higher rates of hospitalization, pneumonia and death

The current report was a matched cohort study using the Nurses’ Health Study looking at women with incident RA with prediagnosis serologic testing and looked for the onset of incident COPD or asthma.

A total of 283 pre‐RA women and 842 controls were studies; 21% of the pre‐RA were ACPA+. Overall they found 107 cases of incident COPD and 105 incident asthma.

Being pre‐RA ACPA+ was associated with 3‐fold increased risk of incident COPD (HR 3.04; 1.33–7.00), independent of smoking and other confounders.

Women with incident RA onset were more likely to develop asthma (HR 1.74; 0.72–4.24) than controls, regardless of ACPA status (pre‐RA ACPA–   HR 1.65; 1.11–2.46).

These data suggest that ACPA+ may be at risk of developing RA, and that they may also be at risk, and should be monitored for, devleoping COPD.

The author has no conflicts of interest to disclose related to this subject

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