Session Information
Title: Rheumatoid Arthritis - Clinical Aspects II: Clinical Features & Comorbidity/Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Interstitial lung disease (ILD) is a common pulmonary manifestation of rheumatoid arthritis (RA), and an important cause of morbidity and mortality in RA patients. We categorized ILD to two groups, as the usual interstitial pneumonia (UIP) pattern and the nonspecific interstitial pneumonia (NSIP) pattern, using chest high-resolution computed tomography (HRCT) scanning. We compared demographic and clinical characteristics of UIP pattern and NSIP pattern in rheumatoid arthritis patients and determined the important prognostic factors that influence the survival of RA-ILD patients.
Methods:
We enrolled 51 RA patients (male n=21, female n=30) with ILD underwent HRCT, between January 2002 and December 2011 in Catholic University Hospital of Daegu.
Results:
Demographics and the clinical characteristics of the 51 RA-ILD patients showed no significant difference between the UIP pattern and NSIP pattern. Comparing the two groups, there were no differences in age at which RA was diagnosed, age at which ILD was diagnosed, RA duration, ILD duration, proportion of steroid and DMARD medication, laboratory study, pulmonary function test and ILD extent on chest HRCT. But RA-NSIP group was younger than RA-UIP group (62.3±11.7 vs 68.2±8.4).
Of the 51 RA-ILD patients, 21(UIP pattern 16 cases, NSIP pattern 5 cases) patients died. More patients died in UIP pattern, but there were no significant differences in survival time between RA-UIP pattern and RA-NSIP pattern (Log rank p=0.985). .
Cox’s regression analysis was performed to find out prognostic factors that affects survival of RA-ILD patients. ILD extent on chest HRCT was strongly associated with mortality (HR=1.044, 95% CI 1.019-1.069). Patients that was diagnosed ILD in older age (HR=1.518, 95% CI 1.109-2.077), high LDH(HR=1.007, 95% CI 1.000-1.014) and high rheumatoid factor (HR=1.004, 95% CI 1.000-1.008), the use of MTX (HR=5.539, 1.332-23.041) were associated with worse survival time. UIP pattern on HRCT, age, sex, smoking history, anti-CCP antibody didn’t have an effect on survival. We divided the extent of the lung disease in to 4 groups ; 1-15%, 16-20%, 21-25%, >25% and compared the survival rate. Comparing four groups, there were significant differences in survival estimates (Log-rank p value= 0.0) based on ILD extent of 15%. The median survival time for ILD extent of less than 15% was 89.4 months, ILD extent of excess of 15% was 49 months.
Conclusion:
Our case studies reveal that the relationship of the UIP pattern to survival is unclear but the extent of ILD on chest HRCT was found to be significantly associated with poor prognosis of RA-ILD patients.
Disclosure:
H. Lee,
None;
J. Y. Choe,
None;
S. K. Kim,
None;
S. H. Park,
None;
J. H. Kim,
None;
D. S. Hyun,
None;
K. J. Jung,
None;
J. Bae,
None.
« Back to 2012 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/important-prognostic-factor-in-rheumatoid-arthritis-patients-with-interstitial-lung-disease-is-not-usual-interstitial-pneumonia-pattern-but-interstitial-lung-disease-extent-on-chest-high-resolution-co/