Background/Purpose: Pulmonary diseases are contributors to the morbidity and mortality of RA. Despite the recent surge in studies of RA-associated interstitial lung disease (RA-ILD), there have been few studies of pulmonary hypertension (PH) in and out of the context of symptomatic RA-ILD. We explored clinical associations and mortality of PH in RA.

Methods: Data were extracted from the electronic medical record of a large, urban, referral medical system between 1/1/2012 and 10/25/24. RA, ILD, and PH were defined based on ICD-10 codes at two distinct time points. We compared clinical characteristics within the RA cases according to the presence/absence of ILD and/or PH. These were further compared with non-RA controls with ILD and/or PH. Generalized linear models were used to adjust for relevant confounders.

Results: A total of 10,824 RA patients were identified. ILD was diagnosed in 526 (5%), among whom 171 (33%) were also diagnosed with PH. PH without ILD was diagnosed in 595 (6%). Among 6,954 non-RA controls with ILD, only 1,649 (24%) also had PH (OR 1.55; p< 0.001 compared with RA). This difference was maintained after adjustment for demographics and smoking (OR=1.41; p=0.001). Within the RA group, those with RA+ILD were less likely to be female than those with RA only (72% vs 78%, respectively, p=0.007), while those with RA+PH and RA+ILD+PH did not differ significantly on sex compared with those with RA only. Black race was more frequent in those with RA+PH and RA+ILD+PH compared with those with RA only (23% and 25% vs. 12%, respectively; p< 0.0001 for both comparisons). Ever smoking was more common for all subtypes of RA lung involvement compared with those with RA only, but current smoking did not differ substantially. Current alcohol use was lower among those with all subtypes of RA lung disease compared with those with RA only. Median CRP was highest in those with RA+ILD and RA+ILD+PH (4.2 and 4.0 mg/L, respectively), and was higher than in those with RA only and RA+PH. Age at death was the lowest for those with RA+ILD+PH (Fig. 1), with a trend to lower age at death for those with RA+ILD+PH compared with those without RA with ILD+PH. Compared with those with ILD, those with ILD+PH, regardless of RA status, had lower adjusted FVC % predicted (Fig. 1).

Conclusion: The combination of ILD and PH may be more prevalent among RA patients compared with those with ILD who do not have RA and is associated with higher morbidity and mortality. Improved screening and management of PH in RA-ILD may reduce this burden.

Figure 1: Adjusted Age at Death and Lowest Forced Vital Capacity According to RA Status and Presence of ILD and/or Pulmonary Hypertension

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-associations-of-pulmonary-hypertension-in-ra-patients-with-and-without-interstitial-lung-disease/