Progressive Decline of Lung Function in Rheumatoid Arthritis-Associated Interstitial Lung Disease.
Progressive Decline of Lung Function in Rheumatoid Arthritis-Associated Interstitial Lung Disease.
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DOI：
10.1002/art.39971
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发表时间：
2017-03
期刊：
影响因子：
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通讯作者：
Matteson EL
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文献类型：
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作者：
Zamora-Legoff JA;Krause ML;Crowson CS;Ryu JH;Matteson EL
间质性肺疾病（ILD）与类风湿性关节炎（RA）的高发病率相关，但对其长期进展知之甚少。 1998 年至 2014 年在 Mayo Clinic 就诊的所有 RA-ILD 患者，经过至少 4 周的随访和至少 1 次肺功能测试 (PFT) 后，均被识别并进行手动筛选以纳入研究。进展被定义为一氧化碳弥散能力 (DLCO) <40% 预测或病情严重而无法执行，或用力肺活量 (FVC) <50% 预测。使用Kaplan-Meier方法分析进展时间。在纳入的 167 名患者中，81 名 (49%) 为女性，诊断 ILD 时平均年龄为 67 岁（标准差：10）。 ILD 诊断后的中位随访时间为 3.3 年（范围：0.01-14.8）。三分之一的患者需要补充氧气，在 ILD 诊断后 5 年内，40% 的患者出现 DLCO < 预测值的 40%，22% 的患者出现 FVC < 预测值的 50%。 DLCO 进展的危险因素是普通间质性肺炎 (UIP) 与非特异性间质性肺炎 (NSIP)（风险比 [HR]：3.29；95% 置信区间 [CI]：1.28、8.41）。基线时预测 DLCO 和 FVC 的百分比较低，会增加进展为 DLCO <40% 和 FVC <50% 预测的风险，前 6 个月内较高的变化率也会增加进展风险。肺功能进行性丧失在 RA-ILD 患者中很常见，而 UIP 患者的情况比 NSIP 患者更严重。 RA-ILD 患者进展的预测因子可以帮助临床医生识别 ILD 进展风险最高的患者。
Interstitial lung disease (ILD) is associated with substantial morbidity in rheumatoid arthritis (RA), but very little is known about its long-term progression. All patients with RA-ILD seen at Mayo Clinic in 1998-2014 with at least 4 weeks follow-up and at least 1 pulmonary function test (PFT) were identified and manually screened for study inclusion. Progression was defined as a diffusing capacity for carbon monoxide (DLCO) <40% predicted or too ill to perform, or a forced vital capacity (FVC) <50% predicted. Time to progression was analyzed using Kaplan-Meier methods. Of 167 included patients, 81 (49%) were female with mean age of 67 years (standard deviation: 10) at ILD diagnosis. Median follow-up time from ILD diagnosis was 3.3 (range: 0.01-14.8) years. A third of patients required supplemental oxygen, 40% developed DLCO <40% predicted and 22% developed FVC <50% predicted by 5 years after ILD diagnosis. Risk factors for DLCO progression were usual interstitial pneumonia (UIP) vs. nonspecific interstitial pneumonia (NSIP) (hazard ratio [HR]: 3.29; 95% confidence interval [CI]: 1.28, 8.41). Lower percent predicted DLCO and FVC at baseline increased the risk for progression to DLCO <40% and FVC<50% predicted, and higher rates of change in the first 6 months also increased the risk of progression. Progressive loss of pulmonary function is common in RA-ILD and worse in patients with UIP than NSIP. Predictors of progression in patients with RA-ILD may aid clinicians in identifying patients at highest risk for progression of ILD.