Relationship Between Rheumatoid Arthritis and Pulmonary Function Measures on Spirometry in the UK Biobank

• Published in: Arthritis & rheumatology (Hoboken, N.J.) Vol. 73; no. 11; pp. 1994 - 2002
• Main Authors: Prisco, Lauren, Moll, Matthew, Wang, Jiaqi, Hobbs, Brian D., Huang, Weixing, Martin, Lily W., Kronzer, Vanessa L., Huang, Sicong, Silverman, Edwin K., Doyle, Tracy J., Cho, Michael H., Sparks, Jeffrey A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-11-2021
• Subjects: Adult; Aged; Airway management; Arthritis; Arthritis, Rheumatoid - physiopathology; Biobanks; Biological Specimen Banks; Body mass; Body mass index; Body size; Confidence intervals; Cross-Sectional Studies; Female; Glucocorticoids; Humans; Lung - physiopathology; Lung diseases; Male; Middle Aged; Population control; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary functions; Respiratory function; Respiratory Function Tests; Rheumatoid arthritis; Smoking; Spirometry; Statistical analysis; United Kingdom; United Kingdom; United Kingdom > UK
• ISSN: 2326-5191; 2326-5205
• DOI: 10.1002/art.41791

Objective
To investigate the independent relationship of rheumatoid arthritis (RA) to the type and severity of pulmonary patterns on spirometry compared to the pulmonary patterns in general population controls.
Methods
In this cross‐sectional study, we investigated the association of RA with pulmonary function measures on spirometry among subjects in the UK Biobank who underwent spirometry for research purposes. RA cases were identified based on self‐report and current disease‐modifying antirheumatic drug/glucocorticoid use. Controls were subjects without RA from the general population. Outcome measures included continuous forced expiratory volume in 1 second percent predicted (FEV1%) and forced vital capacity percent predicted (FVC%), type of spirometric pattern (restrictive or obstructive), and severity of the restrictive or obstructive pattern. We used multivariable regression to estimate the effects in RA cases compared to the effects in controls, adjusting for age, sex, body mass index, and smoking status/pack‐years.
Results
Among 350,776 analyzed subjects who underwent spirometry (mean age 56.3 years; 55.8% female; 45.5% ever smokers), we identified 2,008 cases of treated RA. In multivariable analyses, RA was associated with lower FEV1% (β = –2.93 [95% confidence interval (95% CI) –3.63, –2.24]), FVC% (β = –2.08 [95% CI –2.72, –1.45]), and FEV1/FVC (β = –0.008 [95% CI –0.010, –0.005]) compared to controls. RA was additionally associated with restrictive patterns (odds ratio [OR] 1.36 [95% CI 1.21, 1.52]) and obstructive patterns (OR 1.21 [95% CI 1.07, 1.37]) independent of confounders, and was most strongly associated with severe restrictive and obstructive patterns.
Conclusion
RA is associated with increased odds of restrictive and obstructive patterns, and this relationship is not explained by confounders, including smoking status. In addition to restrictive lung disease, clinicians should also be aware that airway obstruction may be a pulmonary manifestation of RA.