Impact of Interstitial Lung Disease on Mortality of Patients with Rheumatoid Arthritis

Dam Kim¹, Soo-Kyung Cho², Chan-Bum Choi³, Jung-Yoon Choe⁴, Won Tae Chung⁵, Seung-Jae Hong⁶, Young Ok Jung⁷, Tae-Hwan Kim⁸, Tae-Jong Kim⁹, Hye-Soon Lee¹⁰, Joo Hyun Lee¹¹, Jisoo Lee¹², Shin-Seok Lee¹³, Dae-Hyun Yoo¹⁴, Bo Young Yoon¹⁵, Jin Woo Song¹⁶, Sang-Cheol Bae¹⁷ and Yoon-Kyoung Sung¹, ¹Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea, ²Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea, The Republic of, ³Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea, ⁴Medicine, Catholic university of Daegu School of medicine, Daegu, Korea, The Republic of, ⁵Rheumatology, Dong-A University Hospital, Busan, South Korea, ⁶Dept. of Rheumatology, #1 Hoeg, KyungHee University Medical Center, SEOUL, South Korea, ⁷Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea, ⁸Department of Rheumatology, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea, ⁹Chonnam Nat`l University Medical School&Hospital, Chonnam, South Korea, ¹⁰Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea, ¹¹Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea, ¹²Int Medicine, Ewha Woman's Univ Schl of Med, Seoul, Korea, Republic of, ¹³Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea, The Republic of, ¹⁴Division of Rheumatology, Department of Internal Medicine, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea, ¹⁵Rheumatology/Internal medicine, Inje Iniversity Ilsan Paik Hospital, Goyang, Korea, The Republic of, ¹⁶Department of pulmonary and critical care of medicine, Asan medical center, University of Ulsan, College of Medicine, Seoul, Korea, The Republic of, ¹⁷Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea, The Republic of

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: interstitial lung disease, morbidity and mortality and rheumatoid arthritis (RA)

Session Information

Date: Sunday, November 13, 2016

Title: Epidemiology and Public Health - Poster I

Session Type: ACR Poster Session A

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

Background/Purpose: Interstitial lung disease (ILD) is one of the most important extra-articular manifestations in patients with rheumatoid arthritis (RA). The prevalence of ILD in patients with RA has been shown to vary widely between 1% and 58% depending on the study population and the definition of ILD. Some studies have supported ethnicity-related differences in the prevalence of ILD and ILD in RA; however, these results have not yet been conclusive. In addition, ILD is known to be associated with higher mortality; however, the effect of ILD on mortality among Asian RA patients is not enough. In this study, we aimed to determine the prevalence of ILD in Korean patients with RA and assess the effect of ILD on their mortality.

Methods: A total of 3,555 patients with RA with chest X-ray or chest computed tomography (CT) data at enrollment were extracted from the KORean Observational study Network for Arthritis (KORONA) cohort, a nationwide prospective cohort for patients with RA in Korea. Patients were classified into two groups: 1) ILD group as patients with ILD by chest X-rays or chest CT scans, and 2) non-ILD group as patients without ILD by these modalities. After comparing demographic and clinical characteristics at enrollment between the groups, log rank test was used to test the differences in survival between the ILD group and the non-ILD groups. With adjusting age, sex, smoking history, medications, RA severity, and comorbidities, cox proportional hazard model was made to identify the impact of ILD on RA mortality.

Results: Sixty-four patients (1.8%) were identified with ILD. The ILD group patients were older at diagnosis (54.9 ± 11.6 years in ILD group vs. 45.5 ± 12.9 years in non-ILD group, p<0.01) and at enrollment (63.2 ± 9.2 years vs. 53.6 ± 12.1 years, p<0.01) than non-ILD group patients, and male (29.7% vs. 15.5%, p<0.01) patients were more common in the ILD group. In regard to medication, methotrexate was used less (57.8% vs. 82.1%, p<0.01), and oral glucocorticoid was used more (89.1% vs. 76.3%, p=0.03) in the ILD group compared with the non-ILD group. During mean follow-up of 24 months, 6 patients (9.4%) in the ILD group and 25 patients (0.7%) in the non-ILD group died; survival rates were significantly worse in the ILD group (p<0.01) by log-rank test. On adjusted analysis, ILD was significantly associated with an increased mortality risk (HR 9.41, CI 3.63-24.39, p<0.01); the risk of mortality in patients with ILD was even higher than in patients with cardiovascular disease (HR 4.85, CI 2.03-11.64, p<0.01) or malignancy (HR 3.40, CI 1.19-9.68, p=0.02).

Conclusion: The prevalence of ILD was 1.8% in Korean patients with RA. ILD was a major risk factor for increased mortality in p
atients with RA.

Disclosure: D. Kim, None; S. K. Cho, None; C. B. Choi, None; J. Y. Choe, None; W. T. Chung, None; S. J. Hong, None; Y. O. Jung, None; T. H. Kim, None; T. J. Kim, None; H. S. Lee, None; J. H. Lee, None; J. Lee, None; S. S. Lee, None; D. H. Yoo, CELLTRION,Inc., 5; B. Y. Yoon, National Research Foundation of Korea, 2,Inje University, 2; J. W. Song, None; S. C. Bae, None; Y. K. Sung, None.

To cite this abstract in AMA style:

Kim D, Cho SK, Choi CB, Choe JY, Chung WT, Hong SJ, Jung YO, Kim TH, Kim TJ, Lee HS, Lee JH, Lee J, Lee SS, Yoo DH, Yoon BY, Song JW, Bae SC, Sung YK. Impact of Interstitial Lung Disease on Mortality of Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/impact-of-interstitial-lung-disease-on-mortality-of-patients-with-rheumatoid-arthritis/. Accessed .

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