Increased Risk of COPD in ACPA+ Pre-RA Patients Save

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.