Rheumatoid Arthritis-Related Interstitial Lung Disease (RA-ILD): Methotrexate and the Extension of Lung Disease Are Associated to Prognosis

Jorge Rojas-Serrano¹, Denisse Herrera-Bringas², Renzo Perez-Dorame³, Mayra Mejia² and Heidegger Mateos-Toledo⁴, ¹Interstitial Lung Diseases Unit, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico, ²Interstitial Lung Diseases Unit, Insituto Nacional de Enfermedades Respiratorias, Mexico, Mexico, ³Intertitial Lung Disease Unit, Instituto Nacional de Enfermedades Respiratorias, Mexico, Mexico, ⁴Interstitial Lung Diseases Unit, Instituto Nacional de Enfermedades Respiratorias, Mexico, Mexico

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: extraarticular manifestations, interstitial lung disease, Lung Disease, Prognostic factors and rheumatoid arthritis (RA)

Session Information

Date: Monday, November 9, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

Interstitial lung disease (ILD) is a severe rheumatoid
arthritis manifestation with a median survival of 2.6 years. Worst survival has
been associated to usual interstitial pneumonia (UIP)-like patterns in
high-resolution lung CT (HRCT) scans. To date, no formal recommendations to
treat RA-ILD exist. Moreover, the use of methotrexate in RA-ILD is
controversial. Our aim was to evaluate prognostic factors in a RA-ILD cohort, including
extension of lung disease and methotrexate with their association to survival.

Methods:

RA patients (ACR 87 or ACR/EULAR 2010 criteria) with
ILD were included. At the baseline, pulmonary function tests were realized and
a high-resolution chest tomography was obtained. A radiologist evaluated the ILD
tomographic pattern and the extension of lung disease with the Kazerooni index for lung inflammation and fibrosis. The
survival function was estimated and Cox regression was used to evaluate factors
associated to prognosis.

Results:

68 patients were included, mostly females (85%) with a
median age of 58 years old, (IQR: 53-66). UIP tomographic pattern was present
in 18 patients (27%), non-specific interstitial pneumonia (NSIP) pattern in 20
(29.85%), nevertheless, there was considerable overlapping of tomographic
patters with mixed pattern (combination of two ILD tomographic patterns) in 25
of the patients (37%). There was no difference in survival according to the
HRCT pattern of the patients. Variables associated to mortality were the
extension of lung fibrosis according to the Kazerooni
index (HR: 2.53, 95% CI: 1.16 – 5.51, p = 0.02) and the extension of lung
inflammation (ground glass Kazerooni score) (HR: 4.03,
95% CI: 1.56- 10.39, p = 0.004). Treatment with methotrexate was associated to
survival (figure) (HR: 0.13, 95% CI: 0.02 – 0.64, p =0.012). A multivariable
Cox regression analysis including methotrexate treatment, extension of lung
inflammation and extension of lung disease is shown in table.

Variable	HR	95% CI	P
Methotrexate treatment during follow up	0.16	0.02 – 0.99	0.049
Kazerooni ground glass score (lung inflammation)	4.24	1.53 – 11.72	0.005
Kazerooni fibrosis score (lung fibrosis)	1.84	0.65 – 5.2	0.25

Conclusion:

Methotrexate treatment during follow up was associated
with survival. The extension of lung disease and not the tomographic pattern is
associated to mortality.

Disclosure: J. Rojas-Serrano, None; D. Herrera-Bringas, None; R. Perez-Dorame, None; M. Mejia, None; H. Mateos-Toledo, None.

To cite this abstract in AMA style:

Rojas-Serrano J, Herrera-Bringas D, Perez-Dorame R, Mejia M, Mateos-Toledo H. Rheumatoid Arthritis-Related Interstitial Lung Disease (RA-ILD): Methotrexate and the Extension of Lung Disease Are Associated to Prognosis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/rheumatoid-arthritis-related-interstitial-lung-disease-ra-ild-methotrexate-and-the-extension-of-lung-disease-are-associated-to-prognosis/. Accessed .

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