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Chronic lung disease in U.S. Veterans with rheumatoid arthritis and the impact on survival.
- Source :
-
Clinical rheumatology [Clin Rheumatol] 2018 Nov; Vol. 37 (11), pp. 2907-2915. Date of Electronic Publication: 2018 Oct 02. - Publication Year :
- 2018
-
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 (nā=ā2053), 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 ā„ā0.15) 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.
- Subjects :
- Aged
Arthritis, Rheumatoid complications
Arthritis, Rheumatoid drug therapy
Cardiovascular Diseases complications
Chronic Disease
Female
Humans
Longitudinal Studies
Male
Methotrexate therapeutic use
Middle Aged
Multivariate Analysis
Registries
Risk Factors
Severity of Illness Index
Survival Analysis
United States
Antirheumatic Agents therapeutic use
Arthritis, Rheumatoid mortality
Lung Diseases complications
Veterans statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1434-9949
- Volume :
- 37
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Clinical rheumatology
- Publication Type :
- Academic Journal
- Accession number :
- 30280369
- Full Text :
- https://doi.org/10.1007/s10067-018-4314-9