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One of the known co-morbidities in RA is an impact on the lungs, which can present in multiple ways from interstitial lung disease to pulmonary nodules, to an increase in COPD and even lung cancer.
A retrospective cohort study was conducted of all patients with RA in the province of British Columbia between January 1996 and March 2006 to determine the incidence of COPD in patients with RA compared to the general population. RA patients were matched 1:1 with controls with no prior diagnosis of any inflammatory arthritis. Cases and controls with a prior COPD diagnosis were excluded from the cohort.
Patients with RA were found to have a 42% greater risk of developing COPD than the general population. Taking into account that the prevalence of smoking in the province is 17%, this confounder did not account for the increased incidence of COPD in the RA population. Based on this cohort study, it would be prudent to screen for COPD as part of a comprehensive co-morbidity assessment.
Lung cancer incidence in RA was evaluated in a population-based, case-control study linked to the Swedish nationwide cancer registry from 1996-2013. RA was associated with twice the risk for developing lung cancer compared to age- and sex-matched controls. RA was significantly associated with lung cancer development in never or ex-smokers, but not in current smokers. Older age, smoking, RF positivity and/or ACPA positivity and double seropositivity were significant risk factors for lung cancer in RA patients.
Given this increased risk for COPD and lung cancer (both of which are further increased in those who smoke), asking about smoking status should be part of every visit with a health professional. This is currently recommended by smoking cessation experts at the Centre for Addiction and Mental Health (CAMH). Smoking cessation alone is a risk factor for more rapid progression of RA, and continued smoking can result in decreased effectiveness of biologic and traditional DMARD therapies.
For practitioners who are uncomfortable addressing smoking cessation with their patients, the question still needs to be asked so that referral to a smoking cessation program can be made. Many pharmacists across Canada have been trained in smoking cessation. Don't hesitate to refer your patients to pharmacists as a resource to help them quit smoking (I have trained many of them!!).
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About the Author
Carolyn Whiskin
Carolyn Whiskin, BSc. Phm is currently the director of pharmacy programs for the Charlton Centre for Specialized Treatments in Hamilton, Ontario. She also practices pharmacy at Brant Arts Dispensary in Burlington, Ontario and is the pharmacist representative to the Ontario Rheumatology Association’s Model of Care committee.
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