Characteristics and Predictors of Progression Interstitial Lung Disease in Rheumatoid Arthritis Compared with Other Autoimmune Disease: A Retrospective Cohort Study

Abstract

Objectives: To describe the characteristics and progression of interstitial lung disease in patients with associated systemic autoimmune disease (ILD-SAI) and to identify factors associated with progression and mortality. Patients and methods: We performed a multicenter, retrospective, observational study of patients with ILD-SAI followed between 2015 and 2020. We collected clinical data and performed pulmonary function testing and high-resolution computed tomography at diagnosis and at the final visit. The main outcome measure at the end of follow-up was forced vital capacity (FVC) >10% or diffusing capacity of the lungs for carbon monoxide >15% and radiological progression or death. Cox regression analysis was performed to identify factors associated with worsening of ILD. Results: We included 204 patients with ILD-SAI: 123 (60.3%) had rheumatoid arthritis (RA), 58 had (28.4%) systemic sclerosis, and 23 (11.3%) had inflammatory myopathy. After a median (IQR) period of 56 (29.8–93.3) months, lung disease had stabilized in 98 patients (48%), improved in 33 (16.1%), and worsened in 44 (21.5%). A total of 29 patients (14.2%) died. Progression and hospitalization were more frequent in patients with RA (p = 0.010). The multivariate analysis showed the independent predictors for worsening of ILD-SAI to be RA (HR, 1.9 [95% CI, 1.3–2.7]), usual interstitial pneumonia pattern (HR, 1.7 [95% CI, 1.0–2.9]), FVC (%) (HR, 2.3 [95% CI, 1.4–3.9]), and smoking (HR, 2.7 [95%CI, 1.6–4.7]). Conclusion: Disease stabilizes or improves after a median of 5 years in more than half of patients with ILD-SAI, although more than one-third die. Data on subgroups and risk factors could help us to predict poorer outcomes.

Reticulation pattern without honeycombing on high-resolution CT is associated with the risk of disease progression in interstitial lung diseases

“…Another study of IPF patients showed that current or former smokers had longer survival than never smokers [47]. In patients with autoimmune disease associated ILD, current or former smoking was associated with disease progression and mortality [48] whereas, in a study of patients with RA-ILD, the survival was similar between current or former and never smokers [49]. In our study, never smoking was associated with the risk of disease progression in ILD and never smokers had shorter median survival than current or former smokers.…”

Safety and Effectiveness of Abatacept in a Prospective Cohort of Patients with Rheumatoid Arthritis–Associated Interstitial Lung Disease

“…The multivariate analysis also showed that, in patients with RA-ILD treated with abatacept, the more pronounced impairment of FVC and DLCO at initiation of treatment was associated with poorer progression of lung disease. This finding has been reflected in various studies, thus pointing to an association with greater progression of lung disease and mortality [53,54]. However, less attention has been given to the analysis of factors associated with progression and mortality in patients with RA-ILD treated with abatacept.…”

Assessment of Cardiopulmonary Manifestations and its Correlation with Semi-quantitative scoring of High-resolution Computed Tomography in Patients with Autoimmune Rheumatic Diseases.

“…The FVC of all patients (n=204) was 72±16.6 (mean ± SD) and at the end of the study was 68.2±16.2(mean ± SD). [29] Multiple studies showed the correlation between the PFT and CT lung scoring system using different modalities.…”