Atopic dermatitis and the risk of developing rheumatoid arthritis - A population-based cohort study
Dr. Syed received her medical degree from the University of Health Sciences in Pakistan. Subsequently, she went on to pursue her clinical epidemiology research training at the University of Texas MD Anderson Cancer Center, Baylor College of Medicine, and Texas Children’s Hospital in Houston, Texas. Her research to date has focused on immune-mediated disease and their associated co-morbidities. Dr. Syed is also the lead coordinator for the PCORI funded LITE study (home vs office-based phototherapy pragmatic trial), vascular inflammation in psoriasis –Apremilast (Otezla) trial, and genetic mutations in Atopic Dermatitis trial. Her research interests include patient-centered outcomes and comparative effectiveness research.
Atopic Dermatitis (AD), a prevalent skin disease, is associated with immune-mediated inflammation.Data is scarce on its association with other chronic inflammatory conditions such as rheumatoid arthritis (RA), particularly in both adults and children. We aimed to assess the risk of RA in patients with AD, stratified by age, after adjusting for traditional risk factors, using a previously validated algorithm. A population-based cohort study was performed using a UK based EMR database generalizable to the general population [The Health Improvement Network (THIN)].A total of 625,083 adult patients with AD and 409,431 pediatric AD patients were matched on age, practice, and index date to 2,678,888 adult and 1,809,029 pediatric unexposed controls. Hazard ratios (HRs) were calculated using Cox regression models. We observed an increased risk of incident RA in AD patients (<18y HR:1.38; 95% CI 1.14 -1.67); (≥18y HR: 1.18, 95% CI 1.13-1.22). Further stratifying by the severity of AD,the risk of developing RA was higher in adults and children with severe AD compared to controls (HR: 5.64; 95% CI 5.189-6.13) and (HR: 8.35; 95% CI 5.63-12.38) respectively. Effects were attenuated in both pediatric and adults patients with mild (<18 y HR :1.16 ; 95% CI 0.94-1.44) (≥18y HR 0.95; 95% CI 0.90-1.01) and moderate AD (<18y HR 1.17; 95% CI 0.72-1.91) (≥18y HR 1.03; 95% CI 0.97- 1.10). Our findings suggest an overall increased risk of RA in patients with AD, with the association limited to patients with severe AD. This sets the stage for further studies on potential underlying mechanisms
KeywordsPatient centered outcome research, epidemiology, immune mediated disease, co-morbidities
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