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Chronic lung disease in U.S. Veterans with rheumatoid arthritis and the impact on survival
- Source :
- Clinical Rheumatology. 37:2907-2915
- Publication Year :
- 2018
- Publisher :
- Springer Science and Business Media LLC, 2018.
-
Abstract
- 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 :
- Lung Diseases
Male
congenital, hereditary, and neonatal diseases and abnormalities
medicine.medical_specialty
Severity of Illness Index
National Death Index
Article
Arthritis, Rheumatoid
03 medical and health sciences
0302 clinical medicine
Rheumatology
Risk Factors
Internal medicine
medicine
Humans
Longitudinal Studies
Registries
030212 general & internal medicine
Prospective cohort study
Veterans Affairs
Aged
Veterans
030203 arthritis & rheumatology
Proportional hazards model
business.industry
Interstitial lung disease
General Medicine
Middle Aged
respiratory system
medicine.disease
Survival Analysis
United States
respiratory tract diseases
Methotrexate
Cardiovascular Diseases
Antirheumatic Agents
Rheumatoid arthritis
Chronic Disease
Multivariate Analysis
Cohort
Propensity score matching
Female
business
Subjects
Details
- ISSN :
- 14349949 and 07703198
- Volume :
- 37
- Database :
- OpenAIRE
- Journal :
- Clinical Rheumatology
- Accession number :
- edsair.doi.dedup.....012f5824071333465f2ffe23b23ec812