The Association between Retinopathy and Arthritis: Findings from a US National Survey 2005-2008

ABSTRACT

Objective To explore the association between retinopathy and arthritis in a representative sample in the United States.

Methods National Health and Nutrition Examination Survey (NHANES) is a series of biannual surveys in a nationally representative non-institutionalized population of the United States. Two waves of NHANES (2005–2008) were merged in the current analysis. Arthritis status and types of arthritis were obtained from questionnaires. Non-mydriatic fundus photographs were collected among participants aged 40 years and older and retinopathy status was assessed using the Airlie House classification scheme. The association between arthritis and retinopathy was evaluated using logistic regression models.

Results From 6,797 eligible participants, 4,901 had information in terms of arthritis status and gradable fundus photographs of at least 1 eye. Retinopathy was less prevalent in patients with osteoarthritis compared with those without osteoarthritis (11.9% vs 17.5%, P < .05). Participants who had osteoarthritis had 43% reduced relative risk of retinopathy compared to those without, after adjusting for covariates (Odds Ratio [OR] = 0.57, 95% Confidence Interval [CI]: 0.33–0.98). This significant association persisted among diabetic participants (OR = 0.43, 95% CI: 0.19–1.00). However, no significant associations between any arthritis, rheumatoid arthritis, other types of arthritis and retinopathy were noted.

Conclusions Patients with osteoarthritis were less likely to have retinopathy when compared with those without. Further studies investigating the possible protective effects of arthritis physiology and/or arthritis treatment in retinopathy are needed.

KEYWORDS:

• Retinopathy
• arthritis
• rheumatoid arthritis
• osteoarthritis

Abbreviations and Acronyms

OA = Osteoarthritis arthritis; RA = rheumatoid arthritis; DR = diabetic retinopathy; PDR = proliferative DR; NHANES = The National Health and Nutrition Examination Survey; NCHS = National Center for Health Statistics; ETDRS = Early Treatment Diabetic Retinopathy Study; BMI = Body mass index; CRP = C-reactive protein; CKD = chronic kidney disease; eGFR = estimated glomerular filtration rate; CVD = cardiovascular disease; OR = odds ratio; CI = confidence intervals; TNF-α = tumor necrosis factor-alpha; NSAIDs = non-steroidal anti-inflammatory drugs.

Footnotes and Financial Disclosures

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article

Author Contributions

Dr Zhu and Dr Liao had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Zhu, Liao, Wang.

Acquisition, analysis, or interpretation: All authors.

Drafting of the manuscript: Zhu, Liao, Wang.

Critical revision of the manuscript for important intellectual content: Scheetz, Wang.

Statistical analysis: Zhu, Liao, Zhang.

Obtained funding: Wang.

Administrative, technical, or material support: Zhu, Liao, Zhang, Wang.

Study supervision: Zhang, Wang.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The present work was supported by Fundamental Research Funds of the State Key Laboratory in Ophthalmology. The sponsor or funding organization had no role in the design or conduct of this research.