Rheumatoid arthritis associated with glaucoma development: JAMA
South Korea: A recent study in JAMA Network Open suggests that rheumatoid arthritis (RA) is associated with a higher risk of primary open-angle glaucoma (POAG) development. This was especially seen within 2 years after diagnosis or among patients aged 75 years or older.
"The possibility of an immune-mediated common pathophysiological pathway invites further investigation," Seung Hoon Kim, Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea, and colleagues wrote in their study.
The evidence on the association between autoimmunity and neurodegeneration in glaucoma (beyond intraocular pressure-mediated damage) is emerging. However, there is not much evidence on the connection between rheumatoid arthritis (RA), the most common autoimmune disease, with the risk of developing primary open-angle glaucoma (POAG).
Against the above background, the authors aimed to investigate if RA is associated with an increased risk of POAG among Korean older adults in a nationwide propensity-matched cohort study.
The study was conducted using data from the Korean National Health Insurance Service-Senior cohort from 2002 to 2013. Data analysis was performed from November 2020 to July 2021.
The development of POAG was the primary outcome. The cumulative incidence of POAG was calculated using the Kaplan-Meier method, and the incidence rate of POAG was estimated using Poisson regression. The associations between RA and risk of POAG were investigated using a Cox proportional hazards regression model.
Among 10 245 participants, 7490 (73.1%) were women, and the mean age was 67.70 years.
Based on the study, the researchers reported the following findings:
- A total of 2049 patients with incident seropositive RA and 8196 time-dependent, propensity score-matched, risk-set controls were included.
- POAG was developed in 86 of 2049 patients with RA and 254 of 8196 matched controls.
- The cumulative incidence of POAG was higher in the RA cohort than in the matched controls.
- In the RA cohort, the incidence rate of POAG was 981.8 cases per 100 000 person-years, whereas, in the matched controls, the incidence rate was 679.5 cases per 100 000 person-years.
- Patients with RA were more likely to develop POAG than the matched controls (hazard ratio [HR], 1.44).
- Increased POAG risk in the RA cohort was predominantly observed 2 years into the follow-up period (HR, 1.83) and in those aged 75 years or older (HR, 2.12).
"Findings indicate that RA is associated with a higher risk of POAG development, especially within 2 years after diagnosis or among patients aged 75 years or older," wrote the authors. "A common pathophysiological pathway may be present between RA and POAG that is possibly immune-mediated, and the nature of this association warrants further investigation."
Reference:
Kim SH, Jeong SH, Kim H, Park E, Jang S. Development of Open-Angle Glaucoma in Adults With Seropositive Rheumatoid Arthritis in Korea. JAMA Netw Open. 2022;5(3):e223345. doi:10.1001/jamanetworkopen.2022.3345
KEYWORDS: JAMA, glaucoma, rheumatoid arthritis, primary open angle glaucoma, Seung Hoon Kim, autoimmune disease, immune mediated, older adults
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