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The link between COPD and ankylosing spondylitis: A population based study

  • Kassem Sharif
    Affiliations
    Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel

    Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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  • Abdulla Watad
    Affiliations
    Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel

    Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel

    Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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  • Shmuel Tiosano
    Affiliations
    Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel

    Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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  • Yarden Yavne
    Affiliations
    Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel

    Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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  • Anna Blokh Kerpel
    Affiliations
    Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel

    Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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  • Doron Comaneshter
    Affiliations
    Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
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  • Author Footnotes
    1 The two last authors share equal contribution.
    Arnon D. Cohen
    Footnotes
    1 The two last authors share equal contribution.
    Affiliations
    Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel

    Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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  • Author Footnotes
    1 The two last authors share equal contribution.
    Howard Amital
    Correspondence
    Corresponding author at: Department of Medicine 'B', Sheba Medical Center, Tel Hashomer 5262100, Israel.
    Footnotes
    1 The two last authors share equal contribution.
    Affiliations
    Department of Medicine 'B', Sheba Medical Center, Tel-Hashomer, Israel

    Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel

    Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    Search for articles by this author
  • Author Footnotes
    1 The two last authors share equal contribution.
Published:April 06, 2018DOI:https://doi.org/10.1016/j.ejim.2018.04.002

      Highlights

      • In this population-based cross sectional study AS has been shown to be associated with increased risk of COPD.
      • Smoking or the underlying pro-inflammatory milieu in AS could plausibly account for this association.
      • Smoking cessation should be encouraged in AS patients, and COPD screening may be warranted.

      Abstract

      Background

      Ankylosing spondylitis (AS) is one of the most common and severe subtypes of the spondyloarthropathies. Extra-articular involvement among AS patients, including lung disease, has been described widely. Chronic obstructive pulmonary disease (COPD) has been linked to several autoimmune diseases, however, very few studies have investigated the association between AS and COPD.

      Objective

      To assess whether an association exists between AS and COPD.

      Material and methods

      A population-based cross-sectional study was conducted using data retrieved from the largest electronic medical records database in Israel, the Clalit Health Services (CHS). Patients were defined as having AS or COPD when there was at least one such documented diagnosis in their medical records. The proportion of COPD was compared between AS patients and controls. A logistic regression model was used to estimate the association between AS and COPD in a multivariate analysis adjusted for age, gender and smoking status.

      Results

      The study included 4076 patients with AS and 20,290 age- and sex-frequency matched controls. The proportion of COPD in AS patients was higher than in controls (46% vs. 18%, respectively, p < .001). Multivariate logistic regression demonstrated a robust independent association between AS and COPD (OR 1.225, p = .031).

      Conclusion

      Our study supports an association between AS and COPD, further extending the link between COPD and autoimmune diseases. This finding highlights the importance of smoking cessation in AS patients and raises the question of whether COPD screening may be warranted.

      Keywords

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