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Spirometry was conducted at baseline and a second visit after 5\u20137 years. RA was identified based on self-report and disease-modifying antirheumatic drug use; non-RA comparators reported neither. The primary outcomes were annual changes in the per cent-predicted forced expiratory volume in 1\u2009s (FEV\n<jats:sub>1<\/jats:sub>\n%) and per cent predicted forced vital capacity (FVC%). Statistical comparisons were performed using multivariable linear regression. The analysis was stratified based on baseline smoking status and the presence of obstructive pattern (FEV\n<jats:sub>1<\/jats:sub>\n\/FVC &lt;0.7).\n<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>\nAmong participants who underwent baseline and follow-up spirometry, we identified 233 patients with RA and 37\u2009735 non-RA comparators. Among never-smoking participants without an obstructive pattern, RA was significantly associated with more FEV\n<jats:sub>1<\/jats:sub>\n% decline (\u03b2=\u22120.49, p=0.04). However, in ever smokers with \u226510 pack-years, those with RA exhibited significantly less FEV\n<jats:sub>1<\/jats:sub>\n% decline than non-RA comparators (\u03b2=0.50, p=0.02). This difference was more pronounced among those with an obstructive pattern at baseline (\u03b2=1.12, p=0.01). Results were similar for FEV\n<jats:sub>1<\/jats:sub>\n\/FVC decline. No difference was observed in the annual FVC% change in RA versus non-RA.\n<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>\nSmokers with RA, especially those with baseline obstructive spirometric patterns, experienced lower FEV\n<jats:sub>1<\/jats:sub>\n% and FEV\n<jats:sub>1<\/jats:sub>\n\/FVC decline than non-RA comparators. Conversely, never smokers with RA had more FEV\n<jats:sub>1<\/jats:sub>\n% decline than non-RA comparators. Future studies should investigate potential treatments and the pathogenesis of obstructive lung diseases in smokers with RA.\n<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/rmdopen-2024-004281","type":"journal-article","created":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T20:41:35Z","timestamp":1718743295000},"page":"e004281","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Rheumatoid arthritis and changes on spirometry by smoking status in two prospective longitudinal cohorts"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct00608764","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Keigo","family":"Hayashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory 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