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Epidemiology
Research
The association between gastro-oesophageal reflux disease and subsequent rheumatoid arthritis occurrence: a nested case–control study from Taiwan
  1. Herng-Ching Lin1,2,
  2. Sudha Xirasagar3,
  3. Cha-Ze Lee4,
  4. Chung-Chien Huang1,
  5. Chao-Hung Chen4,5,6,7,8
  1. 1 School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
  2. 2 Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
  3. 3 Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, USA
  4. 4 Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
  5. 5 Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
  6. 6 Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
  7. 7 Department of Physiology, Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
  8. 8 Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Dr Chao-Hung Chen; s448{at}eip.mkc.edu.tw

Abstract

Objective Gastro-oesophageal reflux disease (GORD) is a common comorbidity among patients with rheumatoid arthritis (RA). While GORD has been attributed to the antirheumatic medications, no studies of human cohorts have investigated a link between GORD and RA. This study investigates whether GORD is associated with a subsequent RA diagnosis over a 5-year follow-up using a population-based dataset.

Setting Taiwan

Participants We used data from the Taiwan Longitudinal Health Insurance Database. The study group consisted of 13 645 patients with an ambulatory claim showing a GORD diagnosis. We used propensity score matching to select 13 645 comparison patients (one per study patient with GORD).

Intervention We tracked each patient’s claims over a 5-year period to identify those who subsequently received a diagnosis of RA. Cox proportional hazard (PH) regression modelling was used for analysis.

Results Over 5-year follow-up, RA incidence rate per 1000 person-years was 2.81 among patients with GORD and 0.84 among the comparison group. Cox PH modelling showed that GORD was independently associated with a 2.84-fold increased risk of RA (95% CI 2.09 to 3.85) over 5-year follow-up, after adjusting for the number of ambulatory care visits within the year following the index date (to mitigate surveillance bias).

Conclusions We observed that GORD might associate with subsequent RA occurrence. Because current treatment guidelines for RA emphasise early diagnosis and prompt treatment, the observed association between GORD and RA may help acquaint clinicians to patients with GORD with higher RA risk and facilitate early diagnosis and treatment.

  • gastroesophageal reflux disease
  • rheumatoid arthritis
  • epidemiology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-016667

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    Footnotes

    • Contributors C-ZL and H-CL participated in the design of the study and helped to draft the manuscript. C-HC performed the statistical analysis and helped to draft the manuscript. C-ZL conceived the study, participated in the design and coordination and helped to draft the manuscript. SX and C-CH helped to revise and edit the manuscript. All authors reviewed the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available.