Key points Do adults with seropositive rheumatoid arthritis develop primary open-angle glaucoma more frequently than those without rheumatoid arthritis? Findings In this cohort study of 10,245 propensity score-matched Korean older adults, patients with rheumatoid arthritis were more likely than matched controls to subsequently develop primary open-angle glaucoma, with hazard ratios ranging from 1.44 to 1.44. 2.12. Meaning These findings suggest that rheumatoid arthritis is associated with the subsequent development of glaucoma; the possibility of a common immune-mediated pathophysiological pathway warrants further investigation. |
Summary
Importance
Although evidence is emerging that autoimmunity may be associated with neurodegeneration in glaucoma (beyond damage caused by intraocular pressure), there is limited evidence linking rheumatoid arthritis (RA), the most common autoimmune disease, with risk. of developing primary open-angle glaucoma. (POAG).
Aim
To investigate whether RA is associated with an increased risk of POAG among older Korean adults.
Design, environment and participants
A nationwide propensity-matched cohort study was conducted using data from the Korean National Health Insurance Service Senior Cohort from 2002 to 2013. Data analysis was conducted from November 2020 to July 2021. .
Exhibitions
Recent onset AR.
Main Results and Measures
The main result was the development of POAG. The Kaplan-Meier method was used to calculate the cumulative incidence of POAG, and the incidence rate of POAG was estimated using Poisson regression. A Cox proportional hazards regression model was used to investigate associations between RA and POAG risk.
Results
Among 10,245 participants, 7,490 (73.1%) were women and the mean (SD) age was 67.70 (4.84) years. A total of 2049 patients with incident seropositive RA and 8196 time-dependent controls, matched by propensity score and risk score, were included. POAG developed in 86 of 2049 RA patients and 254 of 8196 matched controls.
The cumulative incidence of POAG was higher in the RA cohort than in matched controls.
In the RA cohort, the incidence rate of POAG was 981.8 cases per 100,000 person-years (95% CI, 794.3-1213.7 cases per 100,000 person-years), while in the matched controls, the incidence rate was 679.5 cases per 100,000 person-years (95% CI, 600.8-768.3 cases per 100,000 person-years).
RA patients were more likely to develop POAG than matched controls (hazard ratio [HR], 1.44; 95% CI, 1.13-1.84).
The increased risk of POAG in the RA cohort was predominantly observed at the 2-year follow-up period (HR, 1.83; 95% CI, 1.28-2.61) and in those older than 75 years ( HR, 2.12; 95% CI, 1.34-3.35).
Cumulative incidence of primary open-angle glaucoma (POAG) among patients with incident seropositive rheumatoid arthritis (RA) and their risk-matched controls during follow-up
Conclusions and relevance
These findings suggest that RA is associated with an increased risk of developing POAG, especially within 2 years of diagnosis or among patients aged 75 years or older. There may be a common pathophysiological pathway between RA and POAG possibly mediated by the immune system, and the nature of this association warrants further investigation.
Comments
Study finds potential link between RA and primary open-angle glaucoma
Patients aged 75 years or older who were diagnosed with rheumatoid arthritis (RA) 2 years or less ago had the highest risk of developing primary open-angle glaucoma (POAG).
Rheumatoid arthritis (RA) may be associated with an increased risk of developing primary open-angle glaucoma (POAG), according to a study published in JAMA Network Open .
This risk was highest among RA patients aged 75 years or older, and within 2 years of the patient receiving the RA diagnosis.
Emerging evidence has demonstrated an association between autoimmunity and neurodegeneration in glaucoma, a leading cause of irreversible blindness. To better understand whether there is a relationship between RA and the development of POAG specifically, the study authors conducted a data analysis between November 2020 and July 2021 using data from the Korean National Health Insurance Service-Senior cohort. (NHIS-Senior).
The cohort included data from more than half a million adults aged 60 years and older between 2002 and 2013, but only 10,245 participants were included in this analysis. Of this group, 7490 (73.1%) were women and the mean (SD) age was 67.7 (4.84) years.
A total of 2049 patients in this group had newly diagnosed incident seropositive RA and were prescribed biologic agents or any disease-modifying antirheumatic drug (DMARD) during the time period. A control group of 8196 individuals without RA, matched by propensity score and risk set, was included. The average follow-up period was 4.5 years (2.49), generating 46,142 person-years.
The authors found that patients with RA were more likely to develop POAG compared with patients without RA in the control group (HR, 1.44; 95% CI, 1.13-1.84), with 86 (4 .2%) patients with RA and 254 (3.1%) patients without RA who developed POAG during the follow-up period. Furthermore, the cumulative incidence of POAG was higher among RA patients throughout the follow-up period.
For patients with RA, the incidence rate of POAG was 981.8 cases per 100,000 person-years (95% CI, 794.3-1213.7 cases per 100,000 person-years), while patients without RA had an incidence rate of 679.5 cases per 100,000 person-years (95% CI, 600.8-768.3 cases per 100,000 person-years).
Furthermore, the risk of developing POAG was mainly observed at 2 years of follow-up (HR, 1.83; 95% CI, 1.28-2.61) and in people aged 75 years or older (HR, 2.12; 95% CI, 1.34-3.35) in the RA group. For new RA diagnoses, the risk of POAG was 1.5 times higher among patients with RA within 4 years of diagnosis, compared with patients without RA.
“It is well known that the prevalence of associated systemic symptoms, disease progression, and functional outcomes may vary depending on the age of RA onset,” the authors said. “Various characteristics of laboratory findings or phenotypes in late-onset RA, which are different from those in younger-onset RA, are hypothesized to be associated with RA and subsequent POAG risk, but should be consider additional studies.”
Although this association was found, it does not necessarily indicate a direct causal relationship between RA and POAG. The authors emphasized that this association should be further investigated due to other antibody expressions and cellular responses involved in RA that are simultaneously involved in the development of POAG.
“Our results are consistent with those of previous studies, which confirmed an association between the diagnosis of specific autoimmune diseases, including RA, and subsequent dementia within 5 years,” the authors said. "Considering that POAG has an insidious onset over decades, our results suggest that the immune complex involved in RA has the potential to simultaneously cause damage to tissues that are associated with POAG development, including the retina or nerve. optical".
