Predictors of long-term prognosis in rheumatoid arthritis-related interstitial lung disease

Abstract

The aim of the study was to identify specific clinical and serum protein biomarkers that are associated with longitudinal outcome of RA-associated interstitial lung disease (RA-ILD). 60 RA patients with clinical and serological profiles were assessed by HRCT and pulmonary function tests (PFTs) at baseline (Year 0) and 5 years post enrollment (Year 5). Progression versus non-progression was defined based on changes in Quantitative Modified HRCT scores and PFTs over time. Specific serum protein biomarkers were assessed in serum samples at baseline and Year 5 by Multiplex enzyme-linked immunosorbent assays (ELISAs). At Year 5, 32% of patients demonstrated progressive RA-ILD, 35% were stable, and 33% improved. Baseline age and rheumatoid factor (RF) were significantly different between RA-ILD outcomes of progression vs. no-progression (p < 0.05). Changes in levels of CXCL11/I-TAC and MMP13 over 5 years also distinguished pulmonary outcomes (p < 0.05). A final binary logistic regression model revealed that baseline age and changes in serum MMP13 as well as CXCL11/I-TAC were associated with RA-ILD progression at Year 5 (p < 0.01), with an AUC of 0.7772. Collectively, these analyses demonstrated that baseline clinical variables (age, RF) and shifts in levels of selected serum proteins (CXCL11/I-TAC, MMP13) were strongly linked to RA-ILD outcome over time.

Risk factors for rheumatoid arthritis-associated interstitial lung disease: A retrospective study

“…A recent systematic review and meta-analysis including 29 records concluded that both the presence and higher titers of ACPA were suggested to be significantly associated with an increased risk of RA-ILD [ 4 , 11 , 16 , 17 ]. Pursuant to that, our results were in line with literature data: ACPA positivity and rate were significantly higher in RA-ILD than in RA without ILD, and the absence of ACPA was a protective factor from RA-ILD (OR=0.294; p=0.03).…”

“…Interestingly, selection criteria of 2 groups, especially in terms of disease duration, allowed to avoid confounded factors. Many studies had showed association between higher disease activity and ILD [ 4 , 12 , 21 , 22 ], however the study design must be reviewed.…”

“…Thanks to modern imaging, interstitial lung disease (ILD) is going more described in RA. The reported prevalence of ILD associated with RA (RA-ILD) ranged between 20 and 50% [ 3 , 4 ]. ILD accounts for among the main causes of morbidity and mortality in RA [ 2 ].…”

“…Mastering its diagnosis and management features can significantly change the RA prognosis. However, specific predictive biomarkers of ILD are still lacking, and lead to delay diagnosis [ 4 , 5 ]. On the other hand, the role of disease-modifying antirheumatic drugs (DMARD)’sdrug toxicity in the onset or worsening of ILD is also controversial [ 6 , 7 ].…”

Interstitial lung disease in rheumatoid arthritis: A multidisciplinary problem in rheumatology and pulmonology

“…Частота клинически значимого ИЗЛ при РА колеблется от 6 до 15%, но по данным компьютерной томографии высокого разрешения (КТВР) признаки ИЗЛ обнаруживаются у 30-70% пациентов [18][19][20] и могут предшествовать клинической манифестации артрита [21][22][23][24]. Продолжительность жизни у пациентов с РА-ИЗЛ варьирует от 3 до 10 лет после постановки диагноза ИЗЛ [20], а риск летальности в 2-10 раз выше, чем при РА без ИЗЛ [25][26][27][28][29][30], превосходит этот показатель у пациентов РА с кардиоваскулярной патологией (отношение рисков (HR, hazard ratio) -7,98 и 4,10 соответственно) и соответствует риску летальности при идиопатическом легочном фиброзе (ИЛФ) [31].…”