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Eur Respir J. 2016 Feb;47(2):588-96. doi: 10.1183/13993003.00357-2015. Epub 2015 Nov 19.

Predictors of mortality in rheumatoid arthritis-associated interstitial lung disease.

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Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA
Division of Radiology, National Jewish Health, Denver, CO, USA.
Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Radiology, University of Kentucky, Lexington, KY, USA.
Creighton University School of Medicine, Omaha, NE, USA.
Pontificia Universidad Católica Madre y Maestra, Santiago, Dominican Republic.
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan.
Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO, USA.


Interstitial lung disease (ILD) is a common pulmonary manifestation of rheumatoid arthritis. There is lack of clarity around predictors of mortality and disease behaviour over time in these patients.We identified rheumatoid arthritis-related interstitial lung disease (RA-ILD) patients evaluated at National Jewish Health (Denver, CO, USA) from 1995 to 2013 whose baseline high-resolution computed tomography (HRCT) scans showed either a nonspecific interstitial pneumonia (NSIP) or a "definite" or "possible" usual interstitial pneumonia (UIP) pattern. We used univariate, multivariate and longitudinal analytical methods to identify clinical predictors of mortality and to model disease behaviour over time.The cohort included 137 subjects; 108 had UIP on HRCT (RA-UIP) and 29 had NSIP on HRCT (RA-NSIP). Those with RA-UIP had a shorter survival time than those with RA-NSIP (log rank p=0.02). In a model controlling for age, sex, smoking and HRCT pattern, a lower baseline % predicted forced vital capacity (FVC % pred) (HR 1.46; p<0.0001) and a 10% decline in FVC % pred from baseline to any time during follow up (HR 2.57; p<0.0001) were independently associated with an increased risk of death.Data from this study suggest that in RA-ILD, disease progression and survival differ between subgroups defined by HRCT pattern; however, when controlling for potentially influential variables, pulmonary physiology, but not HRCT pattern, independently predicts mortality.

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