Chronic Lung Disease in U.S. Veterans with Rheumatoid Arthritis and the Impact on Survival

Details

• Alternative Title:
  Clin Rheumatol
• Personal Author:
  England, Bryant R. ; Sayles, Harlan ; Michaud, Kaleb ; Thiele, Geoffrey M. ; Poole, Jill A. ; Caplan, Liron ; Sauer, Brian C. ; Cannon, Grant W. ; Reimold, Andreas ; Kerr, Gail S. ; Baker, Joshua F. ; Mikuls, Ted R.
• Description:
  Introduction/Objectives:
  
  Assess the impact of chronic lung diseases (CLD) on survival in rheumatoid arthritis (RA).
  
  Method:
  
  Among participants in the Veterans Affairs Rheumatoid Arthritis (VARA) Registry, a prospective cohort of U.S. Veterans with RA, we identified CLD and cardiovascular disease (CVD) using administrative and registry data. Demographics, smoking status, RA characteristics including Disease Activity Score in 28 joints (DAS28), and disease-modifying anti-rheumatic drug (DMARD) use were obtained from registry data, which was linked to the National Death Index to obtain vital status. We evaluated associations of CLD with survival using multivariable Cox regression models.
  
  Results:
  
  Among a large (n=2,053), male predominant (91%) RA cohort, 554 (27%) had CLD at enrollment. Mortality risk was increased 1.51-fold (95% CI 1.26–1.81) in RA patients with CLD after multivariable adjustment, a risk that was similar to that observed with CVD (HR CLD alone 1.46 [1.03–2.06]; CVD alone 1.62 [1.35–1.94]). Survival was significantly reduced in those with interstitial lung disease (ILD) as well as other forms of CLD. Mortality risk with methotrexate and biologic use was not different in those with CLD compared to those without (p interaction ≥ 0.15) using multiple exposure definitions and propensity score adjustment.
  
  Conclusions:
  
  Mortality risk is significantly increased in RA patients with CLD. This risk is attributable not only to ILD but also to other chronic lung conditions and does not appear to be substantially greater in those receiving methotrexate or biologic therapies. Comorbid lung disease should be targeted as a means of improving long-term outcomes in RA.
  
  
• Subjects:
  Aged Antirheumatic Agents Arthritis, Rheumatoid Cardiovascular Diseases Chronic Disease Female Humans Longitudinal Studies Lung Diseases Male Methotrexate Middle Aged Multivariate Analysis Registries Risk Factors Severity Of Illness Index Survival Analysis Veterans

  More +
• Source:
  Clin Rheumatol. 37(11):2907-2915
• Pubmed ID:
  30280369
• Pubmed Central ID:
  PMC6442481
• Document Type:
  Journal Article
• Funding:
  Mentored Scholars Program/University of Nebraska Medical Center/ ; R01ES019325/ES/NIEHS NIH HHSUnited States/ ; U54 GM115458/GM/NIGMS NIH HHSUnited States/ ; Physician-Scientist Training Program/University of Nebraska Medical Center/ ; I01 CX000896/CX/CSRD VAUnited States/ ; U54GM115458/GM/NIGMS NIH HHSUnited States/ ; P50 AR060772/AR/NIAMS NIH HHSUnited States/ ; CX000896/U.S. Department of Veterans Affairs/ ; Scientist Development Award/Department of Internal Medicine, University of Nebraska Medical Center/ ; U54 OH010162/OH/NIOSH CDC HHSUnited States/ ; 2P50AR60772/AR/NIAMS NIH HHSUnited States/ ; R25AA020818/AA/NIAAA NIH HHSUnited States/ ; IIR 14-048-3/U.S. Department of Veterans Affairs/ ; R01 ES019325/ES/NIEHS NIH HHSUnited States/ ; IK2 CX000955/CX/CSRD VAUnited States/ ; Specialty Care Center of Innovation/U.S. Department of Veterans Affairs/
• Place as Subject:
  United States
• Volume:
  37
• Issue:
  11
• NIOSHTIC Number:
  nn:20065195
• Collection(s):
  CDC Public Access National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:1ac5b047bd79e2db9bcd9f8465c533c4d127d5088666a9831febe73c5c59a4987a216c38c80c4eb358898f991a240af19f05d444f8812021d6d3fd494b224378
• Download URL:
  https://stacks.cdc.gov/view/cdc/113136/cdc_113136_DS1.pdf
• File Type:
  [PDF - 406.13 KB ]