Chronic lung disease in U.S. Veterans with rheumatoid arthritis and the impact on survival

Bryant England, Harlan Sayles, Kaleb D Michaud, Geoffrey Milton Thiele, Jill A Poole, Liron Caplan, Brian C. Sauer, Grant W. Cannon, Andreas Reimold, Gail S. Kerr, Joshua F. Baker, Ted R Mikuls

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Assess the impact of chronic lung diseases (CLD) on survival in rheumatoid arthritis (RA). 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 were linked to the National Death Index to obtain vital status. We evaluated associations of CLD with survival using the multivariable Cox regression models. Among a large (n = 2053), 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. 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.

Original languageEnglish (US)
Pages (from-to)2907-2915
Number of pages9
JournalClinical Rheumatology
Volume37
Issue number11
DOIs
StatePublished - Nov 1 2018

Fingerprint

Veterans
Lung Diseases
Rheumatoid Arthritis
Chronic Disease
Survival
Registries
Cardiovascular Diseases
Interstitial Lung Diseases
Methotrexate
Mortality
Risk Adjustment
Social Adjustment
Propensity Score
Biological Therapy
Antirheumatic Agents
Joint Diseases
Proportional Hazards Models
Smoking
Demography
Lung

Keywords

  • Biologics
  • Lung disease
  • Methotrexate
  • Mortality
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology

Cite this

Chronic lung disease in U.S. Veterans with rheumatoid arthritis and the impact on survival. / England, Bryant; Sayles, Harlan; Michaud, Kaleb D; Thiele, Geoffrey Milton; Poole, Jill A; Caplan, Liron; Sauer, Brian C.; Cannon, Grant W.; Reimold, Andreas; Kerr, Gail S.; Baker, Joshua F.; Mikuls, Ted R.

In: Clinical Rheumatology, Vol. 37, No. 11, 01.11.2018, p. 2907-2915.

Research output: Contribution to journalArticle

England, Bryant ; Sayles, Harlan ; Michaud, Kaleb D ; Thiele, Geoffrey Milton ; Poole, Jill A ; Caplan, Liron ; Sauer, Brian C. ; Cannon, Grant W. ; Reimold, Andreas ; Kerr, Gail S. ; Baker, Joshua F. ; Mikuls, Ted R. / Chronic lung disease in U.S. Veterans with rheumatoid arthritis and the impact on survival. In: Clinical Rheumatology. 2018 ; Vol. 37, No. 11. pp. 2907-2915.
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abstract = "Assess the impact of chronic lung diseases (CLD) on survival in rheumatoid arthritis (RA). 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 were linked to the National Death Index to obtain vital status. We evaluated associations of CLD with survival using the multivariable Cox regression models. Among a large (n = 2053), 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. 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.",
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