Many abstracts were presented from the British Columbia population claims database. Dr. Diane Lacaille and her team had several insights.
Katherine McGuire (a student who worked with Diane) found that there is MORE incident chronic obstructive lung disease hospitalizations once a patient has a diagnosis of RA (abstract #31). Patients with a diagnosis of COPD prior to RA were excluded. Although there is more smoking in RA patients, rates of smoking in RA compared to the general population were estimated in a range and even if considered very high, there was still an increased risk of new COPD hospitalizations in 24,625 RA cases. The risk was nearly two-fold increased. It is unknown if COPD was overall higher or just hospitalizations (likely the former) and importantly, why this is occurring.
Diane Lacaille also reported that there is narrowing of the mortality gap in RA from the same BC population claims database (abstract #1999). In Ontario, a constant mortality gap for RA over the last few decades was recently published by Dr. Jessica Widdifield, but other data including some from Europe have found that the excess mortality in RA is declining. The current presentation found that RA diagnosed since 2000 and followed for 5 years did not show the excess mortality that was previously present in patients from earlier BC database cohorts. It is still early follow-up but this is promising. I wonder if it is due to:
Better treatment (so less uncontrolled inflammation)
Use of methotrexate at higher doses in more recent years, which is cardioprotective
Other unknown reasons
Stay tuned for more data from BC in the future.
Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.View Full Bio