Background/Purpose: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a common and serious extra-articular manifestation of RA, contributing to ~10% of RA-related mortality. Acute exacerbation (AE) of RA-ILD is often fatal, but its clinical risk factors remain poorly defined.

Methods: We retrospectively analyzed RA-ILD patients treated at our center. The AE group included patients hospitalized for AE between 2013 and 2022. The non-AE group comprised patients attending outpatient care in 2013 who were not hospitalized for AE during the same period. Clinical variables included age, age at RA onset, RA duration, sex, smoking history, use of methotrexate (MTX) and prednisolone (PSL), DAS28-ESR, RF, and ACPA. Univariate analyses were performed using t-tests or chi-square tests. Logistic regression was used for both univariate and multivariate analyses (Forward: LR method). Given a strong correlation between age and age at RA onset (r = 0.719), only the latter was included in multivariate analysis.

Results: Univariate analysis identified age and age at RA onset as significantly associated with AE (p< 0.001 and p=0.003, respectively). Multivariate analysis revealed age at RA onset (OR 1.264, 95% CI 1.099–1.455, p=0.001) and RA duration (OR 1.226, 95% CI 1.067–1.409, p=0.004) as independent risk factors. The model showed moderate explanatory power (Nagelkerke R² = 0.425) and high predictive accuracy (85.7%). In-hospital AE mortality was 40%.

Conclusion: Later onset of RA and longer disease duration independently increased the risk of AE in RA-ILD. These findings highlight the importance of early risk stratification and close monitoring in susceptible patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-for-acute-exacerbation-in-patients-with-rheumatoid-arthritis-associated-interstitial-lung-disease/