| Přispěvatelé: |
[Mena-Vázquez,N, Romero-Barco,CM, Manrique-Arija,S, Godoy-Navarrete,FJ, Ureña-Garnica,I, Redondo-Rodriguez,R, Jimenez-Núñez,FG, Fernández-Nebro,A] Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain. [Mena-Vázquez,N, Fernández-Nebro,A] UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain. [Rojas-Gimenez,M, Ortega-Castro,R] Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. [Rojas-Gimenez,M, Ortega-Castro,R] UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain. [Romero-Barco,CM, Panero Lamothe,B] UGC de Reumatología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. [Francisco,E] UGC de Neumología, Hospital Regional Universitario de Málaga, Málaga, Spain. [Aguilar-Hurtado,MC, Padin-Martín,MI] UGC de Radiodiagnóstico, Hospital Regional Universitario de Málaga, Málaga, Spain. [Añón-Oñate,I] Hospital Universitario de Jaén, Jaén, Spain. [Pérez-Albaladejo,L] Hospital Universitario Virgen de las Nieves, Granada, Spain. [Velloso-Feijoo,ML] Hospital Universitario Virgen de Valme, Sevilla, Spain. [Fernández-Nebro,A] Departamento de Medicina, Universidad de Málaga, Málaga, Spain, Grant for Medical Researchers of the 'Fundación Española de Reumatología' 2019. |
| Popis: |
Objectives: To describe a prospective cohort of patients with rheumatoid arthritis associated with interstitial lung disease (RA-ILD) and identify risk factors associated with disease progression and mortality in this cohort. Patients and methods: We performed a multicenter, prospective, observational study of patients with RA-ILD receiving disease-modifying antirheumatic drugs (DMARDs) between 2015 and 2020. The patients were assessed using high-resolution computed tomography and pulmonary function tests at baseline and at 60 months. The main endpoint was “Progression to ILD at the end of follow-up” in terms of the following outcomes: (1) improvement (i.e., improvement in forced vital capacity (FVC) ≥ 10% or diffusing capacity of the lungs for carbon monoxide (DLCO) ≥ 15% and absence of radiological progression)
(2) nonprogression (stabilization or improvement in FVC ≤ 10% or diffusing capacity of the lungs for carbon monoxide (DLCO) <
15% and absence of radiological progression)
(3) progression (worsening of FVC >
10% or DLCO >
15% and radiological progression)
or (4) death. We recorded demographic and clinical characteristics, lung function, and the incidence of adverse events. A Cox regression analysis was performed to identify factors associated with the worsening of ILD. Results: After 60 months, lung disease had stabilized in 66 patients (56.9%), improved in 9 (7.8%), and worsened in 23 (19.8%). Eighteen patients (15.5%) died, with a mean survival of 71.8 (1.9) months after diagnosis of ILD. The Cox multivariate analysis revealed the independent predictors of worsening of RA-ILD to be usual interstitial pneumonia (hazard ratio (HR), 2.6 (95%CI, 1.0–6.7)), FVC <
80% (HR, 3.8 (95%CI, 1.5–6.7)), anticitrullinated protein antibody titers (HR, 2.8 (95%CI, 1.1–6.8)), smoking (HR, 2.5 (95%CI, 1.1–6.2)), and treatment with abatacept, tocilizumab, or rituximab (HR, 0.4 (95%CI, 0.2–0.8)). During follow-up, 79 patients (68%) experienced an adverse event, mostly infection (61%). Infection was fatal in 10/18 patients (55.5%) during follow-up. Conclusions: Lung function is stable in most patients with RA-ILD receiving treatment with disease-modifying anti-rheumatic drugs (DMARDs), although one-third worsened or died. Identifying factors associated with worsening in RA-ILD is important for clinical management. |
