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Obstructive lung diseases and risk of rheumatoid arthritis


Friedlander HM1, Ford JA1,2, Zaccardelli A1, Terrio AV1, Cho MH2,3,4, Sparks JA1,2. Expert Rev Clin Immunol. 2020 Jan;16(1):37-50. doi: 10.1080/1744666X.2019.1698293. Epub 2020 Jan 6.

Author Information

1 Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA.

2 Harvard Medical School, Boston, MA, USA.

3 Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, Boston, MA, USA. 

4 Brigham and Women's Hospital, Channing Division of Network Medicine, Boston, MA, USA.


Introduction: Smoking is an established risk factor for both lung diseases and rheumatoid arthritis (RA). Chronic mucosal airway inflammation may result in immune tolerance loss, neoantigen formation, and production of RA-related autoantibodies that increase the subsequent risk of RA. In this review, we aimed to summarize the current evidence supporting the role of obstructive lung diseases and subsequent risk of RA.Areas covered: We identified scientific articles discussing the biologic mechanisms linking mucosal airway inflammation and RA risk. We also identified studies investigating asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, chronic tuberculous and nontuberculous mycobacterial infections, and interstitial lung disease with subsequent risk for RA.Expert opinion: The current evidence supports the hypothesis that mucosal airway inflammation may increase the risk of developing RA. However, most studies investigating this relationship have been retrospective and may not have adequately addressed the role of smoking. Larger prospective studies may provide stronger evidence for obstructive lung disease and RA risk. Determining the role of obstructive lung disease in RA pathogenesis may provide opportunity for RA prevention and screening strategies, while identifying novel biologic mechanisms that could offer targets to improve treatment and outcomes.