Bidirectional association between rheumatoid arthritis and chronic obstructive pulmonary disease: a systematic review and meta-analysis

Meijiao Wang; Hejing Pan; Yingqi Zhai; Haichang Li; Lin Huang; Zhijun Xie; Chengping Wen; Xuanlin Li

doi:10.3389/fimmu.2024.1494003

Bidirectional association between rheumatoid arthritis and chronic obstructive pulmonary disease: a systematic review and meta-analysis

Front Immunol. 2024 Dec 2:15:1494003. doi: 10.3389/fimmu.2024.1494003. eCollection 2024.

Authors

Meijiao Wang^#¹, Hejing Pan^#¹, Yingqi Zhai^#¹, Haichang Li¹, Lin Huang¹, Zhijun Xie¹, Chengping Wen¹, Xuanlin Li¹

Affiliation

¹ The Research Institute of Chinese Medicine Clinical Foundation and Immunology, School of Basic Medicine Sciences, Zhejiang Chinese Medical University, Hangzhou, China.

^# Contributed equally.

Abstract

Background: Rheumatoid arthritis (RA) and chronic obstructive pulmonary disease (COPD) are prevalent and incapacitating conditions, sharing common pathogenic pathways such as tobacco use and pulmonary inflammation. The influence of respiratory conditions including COPD on RA has been observed, meanwhile RA may constituting one of the risk factors for COPD. It unclear that whether a bidirectional associate between RA and COPD. Our study aims to explore the bidirectional relationship between RA and COPD.

Methods: We systematically searched PubMed, Cochrane Library, and Embase for observational studies from the databases inception to February 20, 2024, utilizing medical subject headings (MeSH) and keywords. We included studies in which RA and COPD were studied as either exposure or outcome variables. Statistical analyses were conducted employing STATA software (version 14.0). The relationship was reported as odds ratios (OR) and corresponding 95% confidence intervals (CI). Publication bias was assessed using funnel plots and Egger's regression.

Results: Nineteen studies with 1,549,181 participants were included. Risk of bias varied from low to moderate, with evidence levels rated as low or very low. Pooled analysis revealed a significant association between RA and increased COPD risk (OR=1.41, 95%CI 1.13 to 1.76, I² = 97.8%, P=0.003). Subgroup analyses showed similar COPD risk elevations in both of genders, seropositive/seronegative RA, cohort and case control studies. Additionally, there was a significant RA risk increase among those with COPD (OR=1.36, 95%CI 1.05 to 1.76, I² = 55.0%, P=0.022), particularly among females and seropositive RA, and cohort studies.

Conclusion: The meta-analysis identifies a significant bidirectional association between RA and COPD, emphasizing mutually increased risk. Recognizing this connection may can inform proactive approaches to disease prevention and management, potentially reducing the public health burden and improving quality of life.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024518323.

Keywords: COPD; RA; bidirectional association; chronic obstructive pulmonary disease; rheumatoid arthritis.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Arthritis, Rheumatoid* / complications
Arthritis, Rheumatoid* / epidemiology
Female
Humans
Male
Pulmonary Disease, Chronic Obstructive* / complications
Pulmonary Disease, Chronic Obstructive* / epidemiology
Risk Factors

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Joint project of State Administration of Traditional Chinese Medicine Science and Technology Department, and the Zhejiang Provincial Administration of Traditional Chinese Medicine (No.2023C03040), the Natural Science Foundation of Zhejiang Province, China (No. Y21H270014), and the Zhejiang Province Traditional Chinese medicine science and technology project (No.2020ZZ006).