Increased Risk of Acute Pancreatitis in Patients with Rheumatoid Arthritis: A Population-Based Cohort Study.

Chi Ching Chang,Hsiu Li Lin,Hsiu-Chen Lin,Yu Sheng Chang,Li Hsuan Wang,Chi Sheng Chiou,Zoltán Rakonczay

doi:10.1371/journal.pone.0135187

Abstract

The study was conducted to determine whether patients with rheumatoid arthritis (RA) are at increased risk of acute pancreatitis compared with those without RA and to determine if the risk of acute pancreatitis varied by anti-RA drug use. We used the large population-based dataset from the National Health Insurance (NHI) program in Taiwan to conduct a retrospective cohort study. Patients newly diagnosed with RA between 2000 and 2011 were referred to as the RA group. The comparator non-RA group was matched with propensity score, using age and sex, in the same time period. We presented the incidence density by 100,000 person-years. The propensity score and all variables were analyzed in fully adjusted Cox proportional hazard regression. The cumulative incidence of acute pancreatitis was assessed by Kaplan-Meier analysis, with significance based on the log-rank test. From claims data of one million enrollees randomly sampled from the Taiwan NHI database, 29,755 adults with RA were identified and 119,020 non- RA persons were matched as a comparison group. The RA cohort had higher incidence density of acute pancreatitis (185.7 versus 119.0 per 100,000 person-years) than the non-RA cohort. The adjusted hazard ratio (HR) was 1.62 (95% CI [confidence interval] 1.43–1.83) for patients with RA to develop acute pancreatitis. Oral corticosteroid use decreased the risk of acute pancreatitis (adjusted HR 0.83, 95% CI 0.73–0.94) but without a dose-dependent effect. Current use of disease modifying anti-rheumatic drugs or tumor necrosis factor blockers did not decrease the risk of acute pancreatitis. In conclusion, patients with RA are at an elevated risk of acute pancreatitis. Use of oral corticosteroids may reduce the risk of acute pancreatitis.

Highlights

Acute pancreatitis is a common disorder and often associated with significant co-morbidities and substantial mortality rates
Acute pancreatitis based on multivariate Cox proportional hazard analysis The crude hazard ratio (HR) of developing acute pancreatitis during the follow-up period for patients with rheumatoid arthritis (RA) was 1.57 compared with non-RA patients (Table 2)
After adjusting for patients’ gender, age, and other comorbid medical condition, the hazard of developing acute pancreatitis was 1.62 times greater for patients with RA compared with non RA patients (Table 2), suggesting that RA is an independent factor in determining the future risk of acute pancreatitis

Summary

Introduction

Acute pancreatitis is a common disorder and often associated with significant co-morbidities and substantial mortality rates. The etiology of acute pancreatitis is undoubtedly multifactorial. Epidemiological studies have shown that gallbladder stones (cholelithiasis), hypertriglyceridemia, obesity, viral hepatitis, and lifestyle are significant risk factors associated with acute pancreatitis. Clinical or biochemical autoimmune stigmata are present in 40% of patients with idiopathic pancreatitis [8]. Current evidence strongly suggests rheumatoid arthritis, Sjogren’s syndrome, and inflammatory bowel disease are frequently associated with autoimmune pancreatitis [9,10,11,12]. Drug toxicity can be an additional etiologic agent for acute pancreatitis. Limited studies have observed an association between anti-rheumatoid arthritis (RA) drugs and the risk of acute pancreatitis. We intended to determine the risk of developing acute pancreatitis among RA patients with various anti-RA drugs

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Conclusion