Qiang Fu1, Li Wang2, Luling Li3, Yifan Li4, Ran Liu4, Yi Zheng5. 1. Department of Rheumatology and Immunology, The First Affiliated Hospital of University of South China, Hengyang, China. 2. Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. 3. Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital West Hospital Affiliated to Capital Medical University, Beijing, China. 4. Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital West Hospital, Capital Medical University, No. 8 Gong-Ti South Road, Chao yang District, Beijing, China. 5. Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital West Hospital, Capital Medical University, No. 8 Gong-Ti South Road, Chao yang District, Beijing, China. zzyy90fs@126.com.
Abstract
BACKGROUND: Factors associated with progression and survivals in rheumatoid arthritis-associated interstitial lung disease (RA-ILD) have not been described in a large center China cohort. METHODS: Seven-hundred and ninety-one consecutive RA patients who completed lung HRCT were considered as potential participants in this retrospective cohort study. Determinants of ILD progression were identified through multivariable logistic analysis. Cox hazards analysis was used to determine significant variables associated with survival. RESULTS: Of 307 patients diagnosed with RA-ILD, 266 were finally included. The 3-year survival rate of RA-ILD patients was 81.24%, and the 5-year survival rate was 69.71%. A total of 82 deaths occurred during follow-up, of which 56 died of respiratory failure due to ILD progression and/or pneumonia while 14 with malignancies (8 with lung cancer). Logistic regression analysis showed that anti-CCP antibody high titer positive (OR: 4.03, 95% CI: 1.04-15.69) and DLCO% < 45% (OR: 8.31, 95% CI: 2.17-31.75) were independent risk factors for the ILD progression. Cox hazards analysis revealed that advanced age (> 60 years old) of RA-ILD diagnosis (HR: 2.32, 95% CI: 1.27-4.25) and extensive lung involvement on HRCT (HR: 2.19, 95% CI: 1.24-3.87) were associated with worse survival. Treatment with cyclophosphamide (HR: 0.43, 95% CI: 0.26-0.69) was associated with better survival. CONCLUSIONS: In RA-ILD patients, anti-CCP antibody high titer positive and DLCO% < 45% are risk factors for ILD progression. Advanced age and extensive lung involvement on HRCT, rather than the baseline UIP pattern, independently predict mortality after controlling for potentially influential variables. Furthermore, cyclophosphamide treatment helps to improve the prognosis in real-world experience.
BACKGROUND: Factors associated with progression and survivals in rheumatoid arthritis-associated interstitial lung disease (RA-ILD) have not been described in a large center China cohort. METHODS: Seven-hundred and ninety-one consecutive RApatients who completed lung HRCT were considered as potential participants in this retrospective cohort study. Determinants of ILD progression were identified through multivariable logistic analysis. Cox hazards analysis was used to determine significant variables associated with survival. RESULTS: Of 307 patients diagnosed with RA-ILD, 266 were finally included. The 3-year survival rate of RA-ILDpatients was 81.24%, and the 5-year survival rate was 69.71%. A total of 82 deaths occurred during follow-up, of which 56 died of respiratory failure due to ILD progression and/or pneumonia while 14 with malignancies (8 with lung cancer). Logistic regression analysis showed that anti-CCP antibody high titer positive (OR: 4.03, 95% CI: 1.04-15.69) and DLCO% < 45% (OR: 8.31, 95% CI: 2.17-31.75) were independent risk factors for the ILD progression. Cox hazards analysis revealed that advanced age (> 60 years old) of RA-ILD diagnosis (HR: 2.32, 95% CI: 1.27-4.25) and extensive lung involvement on HRCT (HR: 2.19, 95% CI: 1.24-3.87) were associated with worse survival. Treatment with cyclophosphamide (HR: 0.43, 95% CI: 0.26-0.69) was associated with better survival. CONCLUSIONS: In RA-ILDpatients, anti-CCP antibody high titer positive and DLCO% < 45% are risk factors for ILD progression. Advanced age and extensive lung involvement on HRCT, rather than the baseline UIP pattern, independently predict mortality after controlling for potentially influential variables. Furthermore, cyclophosphamide treatment helps to improve the prognosis in real-world experience.
Authors: S L MacDonald; M B Rubens; D M Hansell; S J Copley; S R Desai; R M du Bois; A G Nicholson; T V Colby; A U Wells Journal: Radiology Date: 2001-12 Impact factor: 11.105
Authors: Zulma X Yunt; Jonathan H Chung; Stephen Hobbs; Evans R Fernandez-Perez; Amy L Olson; Tristan J Huie; Rebecca C Keith; William J Janssen; Barbara L Goldstein; David A Lynch; Kevin K Brown; Jeffrey J Swigris; Joshua J Solomon Journal: Respir Med Date: 2017-03-30 Impact factor: 3.415
Authors: Nicole S L Goh; Sujal R Desai; Srihari Veeraraghavan; David M Hansell; Susan J Copley; Toby M Maher; Tamera J Corte; Clare R Sander; Jonathan Ratoff; Anand Devaraj; Gracijela Bozovic; Christopher P Denton; Carol M Black; Roland M du Bois; Athol U Wells Journal: Am J Respir Crit Care Med Date: 2008-03-27 Impact factor: 21.405
Authors: Jonathan G Goldin; David A Lynch; Diane C Strollo; Robert D Suh; Dean E Schraufnagel; Philip J Clements; Robert M Elashoff; Daniel E Furst; Sarinnapha Vasunilashorn; Michael F McNitt-Gray; Mathew S Brown; Michael D Roth; Donald P Tashkin Journal: Chest Date: 2008-07-18 Impact factor: 9.410
Authors: Joshua J Solomon; Jonathan H Chung; Gregory P Cosgrove; M Kristen Demoruelle; Evans R Fernandez-Perez; Aryeh Fischer; Stephen K Frankel; Stephen B Hobbs; Tristan J Huie; Jill Ketzer; Amar Mannina; Amy L Olson; Gloria Russell; Yutaka Tsuchiya; Zulma X Yunt; Pearlanne T Zelarney; Kevin K Brown; Jeffrey J Swigris Journal: Eur Respir J Date: 2015-11-19 Impact factor: 16.671
Authors: Esteban Cano-Jiménez; Tomás Vázquez Rodríguez; Irene Martín-Robles; Diego Castillo Villegas; Javier Juan García; Elena Bollo de Miguel; Alejandro Robles-Pérez; Marta Ferrer Galván; Cecilia Mouronte Roibas; Susana Herrera Lara; Guadalupe Bermudo; Marta García Moyano; Jose Antonio Rodríguez Portal; Jacobo Sellarés Torres; Javier Narváez; María Molina-Molina Journal: Sci Rep Date: 2021-04-28 Impact factor: 4.379
Authors: Maria A Nieto; Maria J Rodriguez-Nieto; Olga Sanchez-Pernaute; Fredeswinda Romero-Bueno; Leticia Leon; Cristina Vadillo; Dalifer D Freites-Nuñez; Juan A Jover; Jose L Álvarez-Sala; Lydia Abasolo Journal: BMC Pulm Med Date: 2021-06-30 Impact factor: 3.317