Rheumatoid Arthritis-Associated Interstitial Lung Disease: Clinical Characteristics and Predictors of Mortality
Rheumatoid Arthritis-Associated Interstitial Lung Disease: Clinical Characteristics and Predictors of Mortality
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DOI：
10.1159/000502551
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发表时间：
2019-11-01
期刊：
影响因子：
3.7
通讯作者：
Bendstrup, Elisabeth
中科院分区：
文献类型：
--
作者：
Hyldgaard, Charlotte;Ellingsen, Torkell;Bendstrup, Elisabeth
前言：间质性肺病(ILD)是类风湿性关节炎(RA)的严重关节外表现，但目前尚无循证治疗方法。正在进行的研究探讨包括RA-ILD在内的抗纤维化治疗在进行性纤维化性ILD(PF-ILD)中的作用。本研究的目的是在一个特征良好的、基于人群的队列中调查PF-ILD的频率和RA-ILD的临床特征。方法：我们确定了2004年至2016年在丹麦奥胡斯ILD转诊中心确诊并随访的RA-ILD患者。使用COX回归模型估计调整后的死亡危险比。使用最近提出的相对用力肺活量(FVC)下降=10%、肺对一氧化碳(DLCO)下降的相对弥散量=15%或症状恶化或放射学表现恶化伴a>；=5的定义来评估PF-ILD的存在。结果：我们确诊了102例RA-ILD患者，其中52%患有PF-ILD。平均随访3.8年，中位生存期7.1年。38名患者在随访期间死亡，大多数死亡原因是呼吸道原因。在多变量模型中，死亡的预测因素是DLCO和高滴度的IgM类风湿因子。结论：肺源性RA-ILD常见，相关病死率高。
Introduction: Interstitial lung disease (ILD) is a serious extraarticular manifestation of rheumatoid arthritis (RA), but no evidence-based therapy exists. Ongoing studies investigate the role of antifibrotic therapies for progressive fibrosing ILD (PF-ILD), including RA-ILD. The aim of the present study was to investigate the frequency of PF-ILD and the clinical characteristics of RA-ILD in a well-characterised, population-based cohort. Methods: We identified patients with RA-ILD diagnosed and followed at the ILD referral centre in Aarhus, Denmark, from 2004 to 2016. Adjusted hazard rate ratios for death were estimated using Cox regression models. The presence of PF-ILD was assessed using recently proposed definitions of relative forced vital capacity (FVC) decline >= 10%, relative diffusion capacity of the lung for carbon monoxide (DLco) decline >= 15% or worsening symptoms or a worsening radiological appearance accompanied by a >= 5 to Results: We identified 102 patients with RA-ILD, and 52% had PF-ILD. Mean follow-up was 3.8 years and median survival was 7.1 years. Thirty-eight patients died during follow-up, and most deaths were from respiratory causes. Predictors of mortality in a multivariate model were DLco and high titres of IgM rheumatoid factor. Conclusion: PF RA-ILD was common and the associated mortality was high.