Incidence, Risk Factors, and Mortality of Clinical and Subclinical Rheumatoid Arthritis–Associated Interstitial Lung Disease: A Population‐Based Cohort

Samhouri, Bilal F.; Vassallo, Robert; Achenbach, Sara J.; Kronzer, Vanessa L.; Davis, John M.; Myasoedova, Elena; Crowson, Cynthia S.

doi:10.1002/acr.24856

Cited by 45 publications

(36 citation statements)

References 38 publications

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“…In a recent study of over 645 American patients diagnosed with RA, Samhouri et al observed a comparable frequency of RA-ILD and reported it to be 67.0% [21]. Our observation is also in line with an Egyptian study where Samy et al evaluated lung function among 160 RA patients and reported RA-ILD in 63.8% of patients.…”

Section: Discussionsupporting

confidence: 91%

Frequency of Interstitial Lung Disease in Rheumatoid Arthritis Patients: A Hospital-Based Study

Iqbal¹,

Khan²,

Hassan³

et al. 2022

Cureus

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Introduction: Among various extra-articular manifestations of rheumatoid arthritis (RA), interstitial lung disease (ILD) is the most frequent and concerning manifestation. The reported frequency of RA-associated ILD (RA-ILD) varies in the literature. The objective of the present study was to determine the frequency of ILD in RA patients at a teaching hospital in Rawalpindi.Methods: 175 male and female patients between 18-70 years were enrolled in the study from January 21, 2022, till July 24, 2022. Patients diagnosed with RA were screened for the concomitant presence of ILD (increased pulmonary markings on chest X-rays and total lung capacity ≤ 80%, predicted on pulmonary function tests). In addition, the frequency of RA-ILD was noted and compared across various subgroups of patients based on age, gender, and disease duration.Results: The mean age of the patients was 45.3 ± 11.5 years. The male-to-female ratio was 1:3.1. The mean disease duration was 6.2 ± 3.5 years at the time of presentation. A total of 118 (67.4%) patients were diagnosed with RA-ILD. The frequency of RA-ILD was significantly higher among patients with a prolonged duration of disease, < 5 years vs. ≥ 5 years (59.1% vs. 75.9%; p-value=0.018). Among 118 patients with RA-ILD, usual interstitial pneumonia (UIP) was the most frequent pattern and was noted in 74 (62.7%) patients, followed by nonspecific interstitial pneumonitis (NSIP), which was noted in 44 (37.3%) patients. When compared, there was no statistically significant difference in the frequency of high-resolution CT (HRCT) pattern of RA-ILD across various subgroups of patients based on age (p-value=0.969), gender (p-value=0.934), and duration of disease (p-value=0.881). Conclusion:In the present study, a substantial proportion of RA patients suffered RA-ILD, which warrants routine screening of these patients for undiagnosed pulmonary involvement so that timely identification and anticipated management may improve the outcome of such cases in future clinical practice.

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Section: Discussionsupporting

confidence: 91%

Frequency of Interstitial Lung Disease in Rheumatoid Arthritis Patients: A Hospital-Based Study

Iqbal¹,

Khan²,

Hassan³

et al. 2022

Cureus

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“…An assessment of patients with ILD who did not fulfil the classification criteria for RA revealed a third of patients who were ACPA-positive developed RA less than three years of their ILD diagnosis (36). Furthermore, there is a significant proportion of patients with RA (27% to 48%) for whom the diagnosis of ILD precedes or occurs at the same time as the onset of RA (5, 37, 38). Of note, a majority of individuals who developed ILD prior to RA were found to have a radiological UIP pattern (37).…”

Section: Discussionmentioning

confidence: 99%

Rheumatoid arthritis and idiopathic pulmonary fibrosis: a bidirectional Mendelian randomisation study

Leavy

Kawano-Dourado

Stewart

et al. 2022

Preprint

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Introduction: A usual interstitial pneumonia (UIP) pattern of lung injury is a key feature of idiopathic pulmonary fibrosis (IPF) and is also observed in up to 40% of individuals with rheumatoid arthritis (RA) related Interstitial Lung Disease (RA-ILD). The RA-UIP phenotype could result from either a causal relationship of RA on UIP or vice versa, or from a simple co-occurrence of RA and IPF due to shared demographic, genetic or environmental risk factors. Methods: We used two-sample bidirectional Mendelian Randomisation (MR) to investigate the causal effects of RA on UIP and of UIP on RA, using variants from genome-wide association studies of RA (separately for seropositive and seronegative RA) and of IPF as genetic instruments. We conducted inverse-variance-weighted fixed-effect MR as a primary analysis and undertook sensitivity analyses to assess potential violations of the key MR assumption of no (horizontal) pleiotropy. Results: Seropositive RA showed a significant protective effect on IPF (Odds Ratio, OR = 0.93; 95% Confidence Interval, CI: 0.87-0.99; P=0.032), while the MR in the other direction showed a strongly significant causal effect of IPF on seropositive RA (OR = 1.06, 95% CI: 1.04-1.08, P=1.22x10-11). Conclusion: Our findings support the hypothesis that RA-UIP may be due to a cause-effect relationship between IPF and RA, rather than due to a coincidental occurrence of IPF in patients with RA. The causal effect of IPF on seropositive RA suggests that patho-mechanisms involved in the development of UIP may promote RA and would suggest that screening for UIP in asymptomatic RA patients may be warranted and may influence therapy management of patients with RA-UIP.

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“…In previous RA cohort follow-up studies, the types of comorbidities that can affect RA activity was focused upon ( 63 , 64 ). Although they have investigated the influence of circulatory system diseases and lipoprotein metabolic disorder on RA activity ( 65 ), none have explored the influence of TCM on the readmission of patients with RA-HL.…”

Section: Discussionmentioning

confidence: 99%

Chinese herbal medicine reduces the risk of readmission in patients with rheumatoid arthritis combined with hyperlipidemia: A population‑based retrospective cohort study

Liu

Fang

et al. 2022

Exp Ther Med

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Rheumatoid arthritis (RA) is a systemic autoimmune disease that is associated with high degrees of disability and mortality. Patients with RA are generally more prone to a multitude of comorbidities, with hyperlipidemia (HL) one of the most frequently observed. Therefore, the present study investigated the possible association between Chinese herbal medicine (CHM) treatment and the risk of readmission in patients with RA combined with HL (RA-HL). The aim of the present study was to potentially provide an evidence-based strategy for decreasing the risk of readmission in patients with RA-HL. The present study enrolled 839 patients with RA admitted to the First Affiliated Hospital of the Anhui University of Chinese Medicine from June 2014 to June 2015. Subsequently, 425 patients with RA were included into the present study after those with incomplete follow-up and laboratory parameter data were excluded. These 425 patients were then classified into the RA-HL and RA-non-HL groups, before incidences of sex distribution, age group, medication and readmission with propensity score matching were all compared. In total 263 patients with RA-HL were then included and arranged into the CHM and non-CHM groups. In particular, the variables of age, sex and diagnosis year between one patient in the CHM group and one in the non-CHM group were adjusted with propensity score matching to decrease selection bias and interference from confounding factors. Finally, 127 patients with RA-HL were included into the CHM group and 127 patients with RA-HL were allocated into the non-CHM group. The proportion of readmitted patients (including RA-HL and RA-non-HL, RA-CHM and RA-non-CHM) was analyzed and compared using the χ 2 test and Kaplan-Meier curves. Bivariate logistics regression analysis was used to evaluate the possible factors that can influence the readmission of patients with RA-HL, whereas the potential association between CHM and improvements in the clinical indicators of the patients with RA-HL was assessed using association rules based on Apriori algorithm. It was found through the follow-up data that patients with RA-HL were at higher risk of readmission compared with that in those with RA-non-HL (P<0.05). The CHM treatments included both oral CHM decoction and Chinese patent medicine, including Xinfeng capsule and Huangqin chubi capsule, which may reduce the risk of readmission and improve the recovery of immune-inflammatory indicators in patients with RA-HL (P<0.05). Overall, CHM, as a protective factor, is associated with a reduced risk of readmission in RA-HL.MINGYU HE, JIAN LIU, YANYAN FANG, FANFAN WANG, XU

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Incidence, Risk Factors, and Mortality of Clinical and Subclinical Rheumatoid Arthritis–Associated Interstitial Lung Disease: A Population‐Based Cohort

Cited by 45 publications

References 38 publications

Frequency of Interstitial Lung Disease in Rheumatoid Arthritis Patients: A Hospital-Based Study

Frequency of Interstitial Lung Disease in Rheumatoid Arthritis Patients: A Hospital-Based Study

Rheumatoid arthritis and idiopathic pulmonary fibrosis: a bidirectional Mendelian randomisation study

Chinese herbal medicine reduces the risk of readmission in patients with rheumatoid arthritis combined with hyperlipidemia: A population‑based retrospective cohort study

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