Association of rheumatoid arthritis with hearing loss: a systematic review and meta-analysis
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Rheumatology International https://doi.org/10.1007/s00296-020-04609-1
INTERNATIONAL
SYSTEMATIC REVIEW
Association of rheumatoid arthritis with hearing loss: a systematic review and meta‑analysis Nikolaos Chaitidis1 · Patroklos Theocharis2 · Charalampos Festas3 · Ioanna Aritzi4 Received: 4 March 2020 / Accepted: 27 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting up to 1% of the worldwide population. RA is associated with multiple extra-articular manifestations (EAMs). Middle ear, cochlea and the auditory nerve are suspected sites of RA activity and hearing loss is a possible novel EAM of RA. Objective was to investigate the association of RA with the different subtypes of hearing loss. This systematic review was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted and the I2 was used to assess heterogeneity. Twelve studies comprising 20,022 RA patients and 79,244 controls were included in this systematic review. All studies were observational and were rated to a moderate rate of bias. RA patients had nearly fourfold increased odds of sensorineural hearing loss (SNHL) compared with controls (OR 3.42; 95% CI 2.50–4.69; I2 = 13). RA patients also had a significantly increased risk of SNHL (RR 2.28; 95% CI 1.88–2.76; I2 = 0). RA patients did not have increased odds of conductive hearing loss (CHL) and mixed hearing loss (MHL) (OR 1.36; 95% CI 0.52–3.55; I2 = 22); (OR 2.73; 95% CI 0.78–9.58; I2 = 0%). RA is significantly associated with SNHL. RA is not associated with CHL and MHL. Early screening of RA patients with pure tone audiometry should be considered. Keywords Rheumatoid arthritis · Hearing loss · Sensorineural hearing loss · Conductive hearing loss · Mixed hearing loss
Introduction Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects primarily the peripheral diarthroses. Pathogenesis of RA involves a complex interaction between environmental triggers and genetic predisposition, resulting in loss of immunologic self-tolerance [1–3]. Even though RA * Nikolaos Chaitidis [email protected] Patroklos Theocharis [email protected] Charalampos Festas [email protected] Ioanna Aritzi [email protected] 1
Hellenic Army Medical Corps, Kastoria, Greece
2
Hellenic Police Medical Center, Thessaloníki, Greece
3
Department of Otorhinolaryngology, 401 General Military Hospital of Athens, Athens, Greece
4
Department of Surgery, General Hospital of Kastoria, Kastoria, Greece
is predominantly known for its articular features, it is also associated with several non-articular manifestations, conveniently labeled as extra-articular manifestations (ΕΑΜs) [4]. ΕΑΜs may affect up to 40% of RA patients. Presence of EAMs can significantly increase the morbidity and mortality rates of RA patients, thereby overshadowing their quality of life [5, 6]. Hearing loss is not yet documented as an EAM of RA. However, in the recent years there
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