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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.

Author information

1
Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA SolomonJ@NJHealth.org.
2
Division of Radiology, National Jewish Health, Denver, CO, USA.
3
Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
4
Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA.
5
Department of Radiology, University of Kentucky, Lexington, KY, USA.
6
Creighton University School of Medicine, Omaha, NE, USA.
7
Pontificia Universidad Católica Madre y Maestra, Santiago, Dominican Republic.
8
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan.
9
Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO, USA.

Abstract

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.

PMID:
26585429
DOI:
10.1183/13993003.00357-2015
[Indexed for MEDLINE]
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