Related factors, increased mortality and causes of death in patients with rheumatoid arthritis-associated interstitial lung disease

Kakutani, Takuya; Hashimoto, Atsushi; Tominaga, Akito; Kodama, Kako; Nogi, Shinichi; Tsuno, Hirotaka; Ogihara, Hideki; Nunokawa, Takahiro; Komiya, Akiko; Furukawa, Hiroshi; Tohma, Shigeto; Matsui, Toshihiro

doi:10.1080/14397595.2019.1621462

Cited by 41 publications

(40 citation statements)

References 39 publications

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“…Among the respiratory diseases, ILD is the most predominant manifestation, and serious morbidity and increased mortality can be expected in some patients with RA-ILD [3,4]. Interestingly, a recent report showed that patients with RA-ILD are also at increased risk for cancer mortality [5]. Compared with RA without ILD, RA-ILD was clearly associated with poor prognosis [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, a recent report showed that patients with RA-ILD are also at increased risk for cancer mortality [5]. Compared with RA without ILD, RA-ILD was clearly associated with poor prognosis [3][4][5]. Clinical physicians should thus recognize that the management of RA-ILD affects the prognosis of RA patients because ILD is a frequent manifestation and a poor prognostic factor in RA.…”

Section: Introductionmentioning

confidence: 99%

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Decision-Making Strategy for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD)

Yamakawa

Ogura

Kameda

et al. 2021

JCM

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Rheumatoid arthritis (RA) is a common type of autoimmune arthritis. Patient clinical outcomes might be influenced by numerous respiratory diseases, but interstitial lung disease (ILD) is the most important comorbidity. RA-associated ILD (RA-ILD) is divided into acute/subacute and chronic forms. In the acute/subacute course, if the disease is severe as indicated by a diffuse alveolar damage pattern, high-dose corticosteroids combined with antimicrobial agents should be promptly initiated while considering the differential diagnoses, primarily acute exacerbation (AE) of RA-ILD, drug-induced pneumonitis, and Pneumocystis pneumonia. As initial therapeutic management in the chronic course, the RA itself should be stabilized without delay; thereafter, the activity of ILD itself can be stabilized, considering the safety of each anti-rheumatic drug. The formation of the usual interstitial pneumonia (UIP) pattern is the most important determinant because lung function can worsen more quickly with this pattern. However, because clinicians can fail to identify specific radiological patterns, it is important to determine whether each patient with RA-ILD has UIP-like lesions such as subpleural reticulation, traction bronchiectasis, and honeycombing especially progressively enlarged cysts. In patients with progressive RA-ILD and high risk for infection or AE of ILD in whom fibrosis is dominant, clinicians should consider starting an anti-fibrotic agent.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Decision-Making Strategy for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD)

Yamakawa

Ogura

Kameda

et al. 2021

JCM

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“…Because the prognosis of RA patients with the complication of ILD is worse, 7 – 9 new biomarkers for ILD in RA may predict the prognosis. AoDILD is an acute hypersensitivity pneumonitis conferring a poor prognosis in RA 11 , 12 ; novel biomarkers would facilitate early detection and treatment of AoDILD and improve the prognosis. Thus, extensive recent studies have aimed to establish robust new specific biomarkers for RA-ILD and to develop many applications.…”

Section: Discussionmentioning

confidence: 99%

“… 7 – 9 RA patients may exhibit usual interstitial pneumonia (UIP) showing honeycombing and irregular linear opacities on chest computed tomography, or non-specific interstitial pneumonia (NSIP) with bilateral ground-glass attenuation patterns observed in subpleural and basal regions of the lung, 10 with the prognosis of the former being worse. 11 …”

Section: Introductionmentioning

confidence: 99%

Biomarkers for interstitial lung disease and acute-onset diffuse interstitial lung disease in rheumatoid arthritis

Furukawa

Oka

Higuchi

et al. 2021

Therapeutic Advances in Musculoskeletal

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Interstitial lung disease (ILD) is frequently a complication of rheumatoid arthritis (RA) as an extra-articular manifestation which has a poor prognosis. Acute-onset diffuse ILD (AoDILD) occasionally occurs in RA and includes acute exacerbation of ILD, drug-induced ILD, and Pneumocystis pneumonia. AoDILD also confers a poor prognosis in RA. Previously-established biomarkers for ILD include Krebs von den lungen-6 and surfactant protein-D originally defined in patients with idiopathic pulmonary fibrosis; the sensitivity of these markers for RA-associated ILD (RA-ILD) is low. Although many studies on ILD markers have been performed in idiopathic pulmonary fibrosis, only a few validation studies in RA-ILD or AoDILD have been reported. Biomarkers for RA-ILD and AoDILD are thus still required. Recently, genomic, cytokine, antibody, and metabolomic profiles of RA-ILD or AoDILD have been investigated with the aim of improving biomarkers. In this review, we summarize current preliminary data on these potential biomarkers for RA-ILD or AoDILD. The development of biomarkers on RA-ILD has only just begun. When validated, such candidate biomarkers will provide valuable information on pathogenesis, prognosis, and drug responses in RA-ILD in future.

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“…Some studies have tried to identify factors that can help us to predict a poorer prognosis and/or greater mortality in patients with ILD-SAI. Poorer prognosis of ILD-SAI has been associated with demographic factors, such as advanced age [7][8][9][10][11][12], male sex [8,10,13,14], and history of smoking [2,15]. Similarly, reduced forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO) [15][16][17] and the UIP radiological pattern in HRCT have also been associated with marked progression and mortality in the different types of ILD-SAI [5,12,[18][19][20][21][22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Related factors, increased mortality and causes of death in patients with rheumatoid arthritis-associated interstitial lung disease

Cited by 41 publications

References 39 publications

Decision-Making Strategy for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD)

Decision-Making Strategy for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD)

Biomarkers for interstitial lung disease and acute-onset diffuse interstitial lung disease in rheumatoid arthritis

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

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