Elevated anti-citrullinated protein antibodies prior to rheumatoid arthritis diagnosis and risks for chronic obstructive pulmonary disease or asthma. Arthritis care & research Zaccardelli, A., Liu, X., Ford, J. A., Cui, J., Lu, B., Chu, S. H., Schur, P. H., Speyer, C. B., Costenbader, K. H., Robinson, W. H., Sokolove, J., Karlson, E. W., Camargo, C. A., Sparks, J. A. 2020


OBJECTIVE: To investigate elevation of anti-citrullinated protein antibodies (ACPA) before RA diagnosis and risks for chronic obstructive pulmonary disease (COPD) or asthma.METHODS: We performed a matched cohort study nested within the Nurses' Health Studies among women who donated blood. Women with incident RA after blood draw (self-reported then confirmed by medical records) were each matched to three controls by age, cohort, year, and menopausal factors. Pre-RA ACPA+ was defined as >99th percentile of control distribution by a research assay or by CCP2 in a subset. Incident COPD and asthma after index date (date of blood draw) were identified by questionnaires. Cox regression estimated HRs for incident COPD or asthma (in separate analyses) associated with pre-RA, pre-RA ACPA+, or pre-RA ACPA- phenotypes each compared to their matched non-RA controls.RESULTS: We analyzed 283 pre-RA women and 842 controls; blood was donated mean of 9.7 years (SD 5.8) before RA diagnosis. Fifty-nine women (20.8%) were pre-RA ACPA+. There were 107 cases of incident COPD and 105 incident asthma cases during 21,489 person-years of follow-up. Pre-RA ACPA+ was associated with increased COPD risk (HR 3.04, 95%CI 1.33,7.00) after adjusting for covariates including smoking pack-years. Pre-RA ACPA+ had a HR for asthma of 1.74 (multivariable 95%CI 0.72,4.24), similar to the risk of asthma for pre-RA ACPA- (HR 1.65, 95%CI 1.11,2.46).CONCLUSION: Women with elevated ACPA before RA diagnosis had increased risk for developing COPD compared to controls. Women who later developed RA were more likely to develop asthma, regardless of pre-RA ACPA status.

View details for DOI 10.1002/acr.24140

View details for PubMedID 31961487