Rheumatoid arthritis-related interstitial lung disease (RA-ILD): a possible association between disease activity and prognosis

• Published in: Clinical rheumatology Vol. 41; no. 6; pp. 1741 - 1747
• Main Authors: Rojas-Serrano, Jorge, Mejía, Mayra, Rivera-Matias, Pedro A., Herrera-Bringas, Denisse, Pérez-Román, Diana I., Pérez-Dorame, Renzo, Mateos-Toledo, Heidegger
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-06-2022; Springer Nature B.V
• Subjects: Clinical trials; Hypotheses; Lung diseases; Medical prognosis; Medicine; Medicine & Public Health; Original Article; Patients; Prognosis; Remission; Rheumatoid arthritis; Rheumatology; Survival; Usual interstitial pneumonia; Interstitial lung disease; Methotrexate; Rheumatoid Arthritis-related interstitial lung disease; Rheumatoid arthritis
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-021-06040-8

Objectives
We hypothesized that RA disease activity might be associated with the survival of RA-ILD patients. To evaluate this possibility, we analyzed data on disease activity during follow-up in an RA-ILD cohort and compared disease activity between surviving patients and those who died during follow-up.
Methods
RA-ILD patients referred for medical evaluation and treatment at a single center, with CDAI scores during all follow up were included. We estimated the HR of the mean of the CDAI score during follow-up with survival. Also, we compared the survival function of patients with high disease activity (CDAI scores ≥ 22) during all follow-up with those with moderate and low disease activity.
Results
Thirty-seven patients were included. The mean of the CDAI score during follow-up was higher in death patients (median 30.8 ± 18.5 Vs. 16.8 ± 11.3), and a single unit increase in the mean of the CDAI score was associated with non-survival, HR:1.07 (95% CI: 1.02 -1.12). Patients with high disease activity during all follow-up (CDAI scores > 22) had lower survival function in comparison with moderate and low disease activity (P = 0.042).
Conclusion
The results of the study suggest that higher RA disease activity is associated with a worse prognosis of RA-ILD patients. The hypothesis that high disease activity is associated with worse survival in RA-ILD patients must be evaluated in more extensive cohort studies and clinical trials.
Key Points:
• RA-ILD patients with high disease activity during follow-up had a worse prognosis than those with moderate or low disease activity.
• The study results suggest the hypothesis that patients with RA-ILD must be treated with a treat to target strategy, with the aim of remission or low RA disease activity.