Rheumatoid arthritis-associated interstitial lung disease: epidemiology, risk/prognostic factors, and treatment landscape

Abstract

Objective. To summarise the epidemiology, risk and prognostic factors, and treatment landscape of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Methods. Targeted and systematic literature reviews were conducted to characterise the epidemiology and treatment landscape associated with RA-ILD, respectively. MEDLINE®, Embase, and CENTRAL were searched via OvidSP in March 2019 and December 2018. The results were narratively summarised.Results. A total of 24 and 20 publications were captured through targeted and systematic literature review, respectively. No randomised controlled trials were identified; publications were observational cohort studies, crosssectional, or case-control. Unadjusted incidence of interstitial lung disease (ILD) ranged from 1.3/1,000 personyears for interstitial pneumonia-type ILD to 5.0/1,000 person-years for 'probable or definite ILD'. Prevalence of ILD ranged from 1.8% to 67% (median: 24.9%) and varied with case definition and sample size. Few publications identified the same risk and prognostic factors; age, male sex, duration of disease, and antibodies to cyclic citrullinated peptides were the most frequently reported risk factors for development of RA-ILD, and age was the most common predictor of mortality. Despite identification of a variety of pharmacotherapeutic interventions, assessment of the comparative efficacy and safety of the available treatments were difficult due to heterogenous reporting of outcomes and small sample size. Conclusion.A wide range of estimates were identified for incidence and prevalence of RA-ILD. Further, there was no consensus on risk and prognostic factors. Sufficiently powered clinical trials are needed to confirm the findings of the observational studies with respect to efficacy and safety of current treatments.

Analysis of risk factors of mortality in rheumatoid arthritis patients with interstitial lung disease: a nationwide, population-based cohort study in Taiwan

“…A systemic review showed the prevalence of RA-ILD ranged from 1.8% to 67% (median: 24.9%). 4 The incidence of RA-ILD in Taiwan’s nationwide population-based cohort study was 0.7%, with an incidence rate ratio (IRR) of 9.05. 5 A recent meta-analysis by Qiu et al 6 has shown 10 factors associated with increased risk of mortality in RA-ILD: older age, male sex, smoking history, lower diffusing capacity of the lung for carbon monoxide, lower forced vital capacity predicted, higher composite physiological index, usual interstitial pneumonia (UIP) pattern on high-resolution CT, emphysema presence and acute exacerbation of ILD.…”

A retrospective study of the efficacy of JAK inhibitors or abatacept on rheumatoid arthritis-interstitial lung disease

“…Pulmonary involvement in RA has been the subject of increasing interest in recent years, particularly interstitial lung disease (ILD) as one of the most severe extra-articular manifestation, leading to progressive respiratory failure (Salaffi et al 2019). ILD occurs in 1.8% to 67% of RA patients, determining a worse prognosis and mortality (Fazeli et al 2021;Spagnolo et al 2018;Raimundo et al 2019). The management and treatment of RA-ILD are challenging because there is still little information available and there are no clinical trials dedicated on the topic, although this aspect is increasingly considered by guidelines (Holroyd et al 2019).…”

Failure and multiple failure for disease modifying antirheumatic drugs in rheumatoid arthritis: Real-life evidence from a tertiary referral center in Italy

“…However, it is underestimated because it is often paucisymptomatic [ 26 ]. Early recognition of lung involvement might reduce the progression to lung fibrosis and be associated with and early introduction of a bDMARD or an optimal therapeutic regimen limiting some csDMARDs as leflunomide that could be detrimental for lung involvement [ 27 ]. In our cohort ILD has a prevalence of 18% and seems to be associated with a worse prognosis in terms of csDMARDs multiple failure, although this data was not confirmed in the multivariable analysis possible reflecting the heterogeneity of enrolled patients in a real-life retrospective cohort.…”