Relationship between rheumatoid arthritis and pulmonary function measures on spirometry in the UK Biobank

Objective: We investigated the independent relationship of rheumatoid arthritis (RA) with type and severity of pulmonary patterns on spirometry compared to general population controls.

Methods: This cross-sectional study investigated the association of RA and pulmonary function measures on spirometry among subjects who had spirometry performed for research purposes in the UK Biobank. RA cases were identified by self-report and current DMARD/glucocorticoid use. General population controls denied RA. Outcomes included continuous % predicted forced expiratory volume in 1 second (FEV1 ) and forced vital capacity (FVC), type of spirometric pattern (restrictive or obstructive), and severity. We used multivariable regression to estimate the effects of RA cases versus controls, adjusting for age, sex, body mass index (BMI), and smoking status/pack-years.

Results: Among 350,776 analyzed subjects with spirometry performed (mean age 56.3 years, 55.8% female, and 45.5% ever smokers), we identified 2,008 cases of treated RA. In multivariable analyses, RA was associated with lower % predicted FEV1 (β -2.93, 95%CI -3.63,-2.24), % predicted FVC (β -2.08, 95%CI -2.72,-1.45), and FEV1 /FVC (β -0.008, 95%CI -0.010,-0.005) than controls. RA was associated with restrictive (OR 1.36, 95%CI 1.21,1.52) and obstructive (OR 1.21, 95%CI 1.07,1.37) patterns independent of confounders. RA had the strongest associations for severe restrictive and obstructive patterns.

Conclusion: RA was associated with increased odds of restrictive and obstructive patterns, and this relationship was not explained by confounders including smoking. In addition to restrictive lung disease, clinicians should also be aware that airflow obstruction may be a pulmonary manifestation of RA.

Keywords: pulmonary; rheumatoid arthritis.