Women with seropositive RA have an almost three-fold increased risk of dying from respiratory disease, a study spanning 36 years reveals.

The Nurses Healthy study involving almost 120,000 women aged 30 to 55 years without RA or other connective tissue disease at baseline found that women with RA had significantly increased total mortality (HR 1.40), respiratory mortality (HR 2.06), and cardiovascular mortality (HR 1.45) compared to women without RA.

The findings were independent of traditional mortality factors such as smoking, the researchers reported in Arthritis Care and Research.

Inflammation may specifically worsen airway obstruction leading to a
 worse disease course for patients with COPD and RA, suggested the authors led by Jeffrey Sparks from the Brigham and Women’s Hospital and Harvard Medical School, Boston.

As there was no specific association between seronegative RA and respiratory mortality, specific factors related to seropositivity may also worsen respiratory disease.

“In particular, immune tolerance loss and production of RA-specific autoantibodies may be initiated in the small airways,” they wrote.

“Clinicians should be aware of the increased mortality risk among RA patients, particularly respiratory mortality in seropositive RA,” they concluded.