Mortality in rheumatoid arthritis patients with pulmonary nontuberculous mycobacterial disease: A retrospective cohort study

Abstract

Objective The aim of this study was to compare long-term mortality following diagnosis of pulmonary nontuberculous mycobacterial (NTM) disease between patients with and without rheumatoid arthritis (RA) and to evaluate predictive factors for death outcomes. Methods We reviewed the electronic medical records of all patients who were newly diagnosed with pulmonary NTM disease at participating institutions between August 2009 and December 2018. Patients were followed until death, loss to follow-up, or the end of the study. Taking into consideration the presence of competing risks, we used the cumulative incidence function with Gray’s test and Fine-Gray regression analysis for survival analysis. Results A total of 225 patients (34 RA patients and 191 non-RA controls) were followed, with a mean time of 47.5 months. Death occurred in 35.3% of RA patients and 25.7% of non-RA patients. An exacerbation of pulmonary NTM disease represented the major cause of death. The estimated cumulative incidence of all-cause death at 5 years was 24% for RA patients and 23% for non-RA patients. For NTM-related death, the 5-year cumulative incidence rate was estimated to be 11% for RA patients and 18% for non-RA patients. Gray’s test revealed that long-term mortality estimates were not significantly different between patient groups. Fine-Gray regression analysis showed that the predictive factors for NTM-related death were advanced age (adjusted hazards ratio 7.28 [95% confidence interval 2.91–18.20] for ≥80 years and 3.68 [1.46–9.26] for 70–80 years vs. <70 years), male sex (2.40 [1.29–4.45]), Mycobacterium abscessus complex (4.30 [1.46–12.69] vs. M. avium), and cavitary disease (4.08 [1.70–9.80]). Conclusions RA patients with pulmonary NTM disease were not at greater risk of long-term mortality compared with non-RA patients. Rather, advanced age, male sex, causative NTM species, and cavitary NTM disease should be considered when predicting the outcomes of RA patients with pulmonary NTM disease.

Clinical characteristics and prognostic factors of non-tuberculous mycobacterial disease in patients with rheumatoid arthritis

“…When compared with the NB form, the NB with FC form was associated with a significantly increased risk of mortality (HR = 4.20, 95% CI: 1.32–13.31, p = 0.015). This is consistent with the findings of previous studies [ 8 , 11 ]. The FC form, NB with FC form, and other disease forms are poor prognostic factors for mortality [ 8 ]; cavitary disease is a predictive factor for NTM-related mortality [ 11 ].…”

Factors Associated with Treatment Outcome in Patients with Nontuberculous Mycobacterial Pulmonary Disease: A Large Population-Based Retrospective Cohort Study in Shanghai

“…An increasing number of studies have confirmed that certain chest imaging features, such as bronchiectasis and pulmonary cavitations, are related to the prognosis of patients with NTMPD [24,31,32]. Similarly, patients with NTMPD often present with bronchiectasis [33][34][35].…”

Factors Associated With Treatment Outcome in Patients With Nontuberculous Mycobacterial Pulmonary Disease: a Large Population-based Retrospective Cohort Study in Shanghai

“…An increasing number of studies have con rmed that chest imaging features are related to the prognosis of patients with NTMPD [23,30,31] , such as bronchiectasis and pulmonary cavity. Patients with NTMPD often present with bronchiectasis [32][33][34] .…”