OBJECTIVE To determine the prevalence of comorbidities in rheumatoid arthritis (RA), discover which comorbidities might predispose to developing RA, and identify which comorbidities are more likely to develop after RA. PATIENTS AND METHODS We performed a case-control study using a single-center biobank, identifying 821 cases of RA (143 incident RA) between January 1, 2009, and February 28, 2018, defined as 2 diagnosis codes plus a disease-modifying antirheumatic drug. We matched each case to 3 controls based on age and sex. Participants self-reported the presence and onset of 74 comorbidities. Logistic regression models adjusted for race, body mass index, education, smoking, and Charlson comorbidity index. RESULTS After adjustment for confounders and multiple comparisons, 11 comorbidities were associated with RA, including epilepsy (odds ratio [OR], 2.13; P=.009), obstructive sleep apnea (OR, 1.49; P=.001), and pulmonary fibrosis (OR, 4.63; P<.001), but cancer was not. Inflammatory bowel disease (OR, 3.82; P<.001), type 1 diabetes (OR, 3.07; P=.01), and venous thromboembolism (VTE; OR, 1.80; P<.001) occurred more often before RA diagnosis compared with controls. In contrast, myocardial infarction (OR, 3.09; P<.001) and VTE (OR, 1.84; P<.001) occurred more often after RA diagnosis compared with controls. Analyses restricted to incident RA cases and their matched controls mirrored these results. CONCLUSION Inflammatory bowel disease, type 1 diabetes, and VTE might predispose to RA development, whereas cardiovascular disease, VTE, and obstructive sleep apnea can result from RA. These findings have important implications for RA pathogenesis, early detection, and recommended screening.

中文翻译：

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合并症是类风湿关节炎的危险因素，在诊断后应计入。

目的要确定类风湿关节炎（RA）的合并症患病率，发现哪些合并症可能会诱发RA，并确定哪些合并症在RA后更容易发展。患者和方法我们使用单中心生物库进行了病例对照研究，确定了2009年1月1日至2018年2月28日之间的821例RA（143例RA），定义为2个诊断代码和一种可改变疾病的抗风湿药药品。我们根据年龄和性别将每个病例与3个对照进行匹配。参与者自我报告了74种合并症的存在和发作。对种族，体重指数，教育程度，吸烟和查尔森合并症指数进行调整的逻辑回归模型。结果经过校正混杂因素和多重比较后，有11例合并症与RA，包括癫痫（优势比[OR]，2.13； P = .009），阻塞性睡眠呼吸暂停（OR，1.49； P = .001）和肺纤维化（OR，4.63； P <.001），但癌症并非如此。与RA诊断相比，炎症性肠病（OR，3.82； P <.001），1型糖尿病（OR，3.07； P = .01）和静脉血栓栓塞症（VTE； OR，1.80； P <.001）发生率更高与控件。相反，与对照组相比，RA诊断后心肌梗死（OR，3.09； P <.001）和VTE（OR，1.84； P <.001）发生率更高。仅限于发生RA事件的分析及其匹配的对照反映了这些结果。结论炎症性肠病，1型糖尿病和VTE可能是RA的诱发因素，而RA可能导致心血管疾病，VTE和阻塞性睡眠呼吸暂停。这些发现对于RA的发病机理具有重要意义，