Clinical features of acute exacerbation in rheumatoid arthritis-associated interstitial lung disease: Comparison with idiopathic pulmonary fibrosis
Clinical features of acute exacerbation in rheumatoid arthritis-associated interstitial lung disease: Comparison with idiopathic pulmonary fibrosis
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DOI：
10.1016/j.rmed.2022.106898
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发表时间：
2022-06-10
影响因子：
4.3
通讯作者：
Yoshida, Makoto
中科院分区：
文献类型：
--
作者：
Otsuka, Junji;Yoshizawa, Shigeru;Yoshida, Makoto
背景：已有多项研究报道在特发性肺纤维化(IPF)的临床病程中发生急性加重(AE)，类风湿性关节炎相关间质性肺疾病(RA-ILD)也会发生急性加重。然而，作为RA-ILD患者主要死亡原因的AE的发生率、临床特征和危险因素，以及RA-ILD和IPF在临床方面的差异尚未完全了解。方法：我们回顾了149例RA-ILD和305例IPF患者的资料。我们调查了RA-ILD合并AE和不合并AE的频率，并比较了RA-ILD合并和不合并AE的临床资料，以明确AE的危险因素。结果：27例(18.1%)RA-ILD和84例(27.5%)IPF患者发生了AE。RA-ILD组和IPF组的中位生存期分别为277d和60d(对数等级，p=0.038)。在多因素分析中，低白蛋白血症[优势比(OR)0.090(95%CI 0.011~0.733)，p=0.012]和一氧化碳弥散能力(%DLCO)[OR.0.810(95%CI 0.814~0.964)，p<；0.01]是AE的独立危险因素。AE是RA-ILD和IPF最常见的死亡原因。结论：RA-ILD患者可发生AE，在RA-ILD和IPF中AE并不少见。DLCO%和低蛋白血症是RA-ILD发生AE的预测因素。RA-ILD组的预后明显好于IPF组。RA-ILD和IPF最常见的死亡原因是AE。
Background: Several studies have reported that acute exacerbation (AE), which occurs during the clinical course of idiopathic pulmonary fibrosis (IPF), also occurs in rheumatoid arthritis-associated interstitial lung disease (RA-ILD). However, the incidence, clinical features, and risk factors for AE, a major cause of death of RA-ILD patients, and the differences in clinical aspects of AE between RA-ILD and IPF have yet to be fully understood.Methods: We retrospectively reviewed data on 149 RA-ILD patients and 305 IPF patients. We investigated the frequency of AE and compared the clinical data between RA-ILD with and without AE to clarify the risk factor for AE. We also compared the post-AE prognosis and cause of death between RA-ILD and IPF patients.Results: Twenty-seven (18.1%) RA-ILD patients and 84 (27.5%) IPF patients developed AE. The median survival time (MST) after AE of RA-ILD and IPF was 277 days and 60 days, respectively (log rank, p = 0.038). In a multivariate analysis, hypoalbuminemia [odds ratio (O.R.) 0.090 (95%CI 0.011-0.733), p = 0.012] and % carbon monoxide diffusion capacity (%DLCO) [O.R. 0.810 (95%CI 0.814-0.964), p < 0.01] were independent risk factors for AE. AE was the most frequent cause of death of RA-ILD and IPF.Conclusion: RA-ILD patients could develop AE, and AE was not uncommon in RA-ILD or IPF. %DLCO and hypoalbuminemia were predictive factors of AE in RA-ILD. The prognosis after AE of RA-ILD was significantly better than that of IPF. The most frequent cause of death in RA-ILD and IPF was AE.