Timing of sinusitis and other respiratory tract diseases and risk of rheumatoid arthritis

Vanessa L. Kronzer, Weixing Huang, Cynthia S. Crowson, John M. DavisIII, Robert Vassallo, Tracy J. Doyle, Elena Losina, Jeffrey A. Sparks

Research output: Contribution to journalArticlepeer-review


Objective: To investigate the association between timing of respiratory tract diseases and risk of rheumatoid arthritis (RA). Methods: This case-control study using the Mass General Brigham Biobank matched incident RA cases, confirmed by ACR/EULAR criteria, with at least seven years preceding electronic health record (EHR) data to three controls on age, sex, and EHR history from RA diagnosis (index date). We ascertained timing (>0-5 years/>5–10 years/>10 years) of the first documented respiratory tract disease prior to index date using diagnosis codes. We estimated odds ratios (OR) with 95% confidence intervals (CI) for RA for each respiratory exposure using logistic regression models, adjusting for potential confounders. We also conducted a stratified analysis by serostatus and smoking. Results: We identified 625 incident RA cases (median 56 years, 75% female, 57% seropositive) and 1,875 controls. Acute sinusitis was associated with RA only in the >5 to 10 years before RA (OR 3.90, 95% CI:1.90,8.01). In contrast, pneumonia was associated with RA only in the >0 to 5 years before RA (OR 1.73, 95% CI:1.00,3.00), and chronic respiratory tract diseases only >10 years before RA (OR 1.43, 95% CI:1.00,2.05). All respiratory tract diseases tended to show a stronger association with seronegative RA than seropositive RA, although the interaction was statistically significant only for chronic sinusitis (p=0.04). Respiratory diseases showed a nonsignificantly stronger association among smokers than nonsmokers. Conclusion: Sinusitis and other respiratory diseases are associated with increased risk of RA, especially 5 years before RA onset. RA may begin many years before clinical onset.

Original languageEnglish (US)
Article number151937
JournalSeminars in Arthritis and Rheumatism
StatePublished - Feb 2022


  • Epidemiology
  • Pharyngitis
  • Rheumatoid arthritis
  • Sinusitis
  • Smoking

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine


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