Abstract
Objectives: Studies on the relationship between rheumatoid arthritis (RA) and alopecia areata (AA) are limited. This study investigated the effect of RA on alopecia areata risk in a nationwide cohort study.Methods: We analyzed 2000–2012 data from the Longitudinal Health Insurance Database in Taiwan. The follow-up period was extended up to the end of 2013. We defined RA as a diagnosis using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 714.0 during at least three outpatient visits or one admission and the use of disease-modifying antirheumatic drugs (DMARDs) for >30 days. The enrollees with AA were identified using the ICD-9-CM code 704.01. We enrolled a comparison cohort comprising participants randomly matched by age and sex, with the same index date as that of the study cohort. Furthermore, we investigated alopecia risk by using Cox proportional-hazards regression models after propensity score matching for sex, age, comorbidities, and medication use.Results: In total, 2,905 patients with RA (74% women, mean age: 51.9 years) and 2,905 controls were followed for 22,276 and 25,732 person-years, respectively. Alopecia risk was 2.64-fold (95% confidence interval = 1.47–4.76) higher in patients with RA than in patients without RA after age, sex, comorbidities, and medication use were adjusted for. In addition, patients with thyroid disease presented considerable alopecia risk. Patients with RA in the younger age group (20–40 years) had the highest alopecia risk.Conclusions: Alopecia risk is significantly higher in patients with RA than in those without RA, particularly in the younger age group (20–40 years). RA assessment should be considered when examining patients with alopecia, especially young adults.
Highlights
Alopecia occurs worldwide, with a lifetime incidence of ∼2% in the general population [1]
Autoimmune disorders, including rheumatoid arthritis (RA), play a role in the comorbid condition associated with alopecia [6]
2,911 patients were included in the RA cohort and 29,100 individuals without RA were included in the control cohort
Summary
With a lifetime incidence of ∼2% in the general population [1]. It is usually characterized by unpredictable, recurring, chronic, and nonscarring loss of hair on the scalp or other areas [2]. Alopecia is not a cosmetic problem because it is associated with several comorbidities that may affect the patients’ overall health and cause considerable morbidity [3,4,5]. Autoimmune disorders, including rheumatoid arthritis (RA), play a role in the comorbid condition associated with alopecia [6]. Alopecia may present early in patients with RA, even before the more classical form of RA is identified. Diagnosis and appropriate treatment by a multidisciplinary team of clinicians are crucial for preventing further manifestations and yielding beneficial longterm outcomes in patients
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