Characteristics and Predictors of Progression Interstitial Lung Disease in Rheumatoid Arthritis Compared with Other Autoimmune Disease: A Retrospective Cohort Study

• Published in: Diagnostics (Basel) 2021-09, Vol.11 (10), p.1794
• Main Authors: Mena-Vázquez, Natalia, Rojas-Gimenez, Marta, Romero-Barco, Carmen María, Manrique-Arija, Sara, Hidalgo Conde, Ana, Arnedo Díez de los Ríos, Rocío, Cabrera César, Eva, Ortega-Castro, Rafaela, Espildora, Francisco, Aguilar-Hurtado, María Carmen, Añón-Oñate, Isabel, Pérez-Albaladejo, Lorena, Abarca-Costalago, Manuel, Ureña-Garnica, Inmaculada, Velloso-Feijoo, Maria Luisa, Redondo-Rodriguez, Rocio, Fernández-Nebro, Antonio
• Format: Article
• Language: English
• Subjects: Age; Biopsy; Cohort analysis; Immunosuppressive agents; interstitial lung disease; Laboratories; Lung diseases; Lungs; Medical prognosis; Mortality; Multivariate analysis; Patients; Pneumonia; prognosis; Rheumatoid arthritis; Rheumatology; RNA polymerase; Steroids; systemic autoimmune disease; Variables
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics11101794

Objectives: To describe the characteristics and progression of interstitial lung disease in patients with associated systemic autoimmune disease (ILD-SAI) and to identify factors associated with progression and mortality. Patients and methods: We performed a multicenter, retrospective, observational study of patients with ILD-SAI followed between 2015 and 2020. We collected clinical data and performed pulmonary function testing and high-resolution computed tomography at diagnosis and at the final visit. The main outcome measure at the end of follow-up was forced vital capacity (FVC) >10% or diffusing capacity of the lungs for carbon monoxide >15% and radiological progression or death. Cox regression analysis was performed to identify factors associated with worsening of ILD. Results: We included 204 patients with ILD-SAI: 123 (60.3%) had rheumatoid arthritis (RA), 58 had (28.4%) systemic sclerosis, and 23 (11.3%) had inflammatory myopathy. After a median (IQR) period of 56 (29.8–93.3) months, lung disease had stabilized in 98 patients (48%), improved in 33 (16.1%), and worsened in 44 (21.5%). A total of 29 patients (14.2%) died. Progression and hospitalization were more frequent in patients with RA (p = 0.010). The multivariate analysis showed the independent predictors for worsening of ILD-SAI to be RA (HR, 1.9 [95% CI, 1.3–2.7]), usual interstitial pneumonia pattern (HR, 1.7 [95% CI, 1.0–2.9]), FVC (%) (HR, 2.3 [95% CI, 1.4–3.9]), and smoking (HR, 2.7 [95%CI, 1.6–4.7]). Conclusion: Disease stabilizes or improves after a median of 5 years in more than half of patients with ILD-SAI, although more than one-third die. Data on subgroups and risk factors could help us to predict poorer outcomes.