Smoking Increases Risk of Lung Disease In RA
Rheumatoid Arthritis Increases Risk for COPD in Women
Women with RA may have a genetic disposition for developing certain lung problems, such as emphysema, chronic bronchitis, and other types of chronic obstructive pulmonary disease (COPD).
By Beth Levine
Medically Reviewed by Alexa Meara, MD
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Rheumatoid arthritis is a systemic disease that affects the body beyond your joints — it can hurt your lungs, too. If you are diagnosed with rheumatoid arthritis (RA), you and your rheumatologist should be watching out for symptoms of chronic obstructive pulmonary disease (COPD), an overall term for progressive lung diseases, such as emphysema, chronic bronchitis, and more.
The Nurses’ Health Studies, a 38-year-long look at women’s risk factors for chronic diseases, found that women with RA had a 68 percent greater risk for developing COPD compared with women without RA.
Researchers Adjusted for Smoking Risks for the First Time
The big news from this study is that for the first time, researchers had access to smoking data, so they could adjust for that influence. “We adjusted for smoking that occurred in every cycle in 38 years of follow-up, and we looked at smoking before and after RA diagnosis,” says Jeffrey A. Sparks, MD, assistant professor of medicine in the division of rheumatology, immunology, and allergy at Brigham and Women’s Hospital and Harvard Medical School in Boston.
Prior Research Established the RA-Lung Link
A Canadian study published online in October 2019 in the journalArthritis Care & Researchdiscovered that people with rheumatoid arthritis were at 47 percent greater risk of hospitalization for COPD than those in the control group. Although this study only looked at the rate of hospitalization, not the rate of developing COPD, there is a correlation, explains study author Diane Lacaille, MD, of Arthritis Research Canada and the University of British Columbia. She notes, “We only looked at hospitalization for a new diagnosis for COPD. Anyone who had COPD before was excluded.”
This study also took into consideration the possible effect of smoking and found that the risk is still increased, says Dr. Lacaille.
Gender Matters With Rheumatoid Arthritis
The first study only looked at women, because 75 percent of people with RA are female. “However, the baseline risk of COPD is generally more common in men than women. Therefore, the increased risk of COPD is greater in women than men because COPD is rarer in women,” explains Lacaille.
What’s the Connection Between RA and Lung Disease?
More research needs to be conducted to firmly establish the reason for the higher COPD risk, but experts have their theories. “It might be something shared between the two diseases — inflammation, autoimmunity, or genetic predispositions. Also, once people are diagnosed with RA, they can be prescribed certain medications that have lung-adverse effects,” says Dr. Sparks.
What People Living With RA and Their Doctors Need to Know
Lacaille has a three-pronged approach to controlling RA and COPD:
1. “These findings emphasize the importance of controlling inflammation in people with RA, not only to prevent joint damage, but also to prevent complications of chronic inflammation elsewhere in the body that can lead to other chronic diseases, such as cardiovascular diseases and COPD.”
2. “It’s really important to address risk factors for COPD in people with RA. Most important is smoking. People who smoke have greater inflammation and are less responsive to treatment. Smoking also increases the risk of cardiovascular diseases, which are more common in RA. Smoking increases the risk of COPD and makes it worse if you continue to smoke.” If you need help quitting, check out SmokeFree.gov.
3. “Clinicians need to watch for signs of COPD in RA patients so they can treat it early before there is damage to the lungs.” According to The COPD Foundation, symptoms are:
- Increased breathlessness
- Tightness in the chest
It is caused most often by smoking, environmental factors like secondhand smoke and workplace pollutants (such as chemicals, dust, and noxious fumes), and genetic predisposition.
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