Background/Purpose: Rheumatoid arthritis (RA) is a systemic inflammatory disease that affects various organs including the lung. The pulmonary involvement is critical for prognosis of the patients and decision of the treatment. Moreover, the pulmonary involvement includes many pulmonary abnormalities such as interstitial lung disease (ILD), nodular lesions and airway disease (AD) and shows various patterns in the progression. Treatment of RA patients, according to the risk factors for the newly developing / worsening pulmonary abnormalities would be required. However, it is not fully identified what the risk factors are. The aim of this study is to identify the risk factors for newly developing pulmonary abnormalities in RA patients under the bDMARDs therapy.

Methods: Subjects were consecutive 208 RA patients started treatment with bDMARDs from 2004 to 2015 in our department and received HRCT scan before and after starting the therapy. Pulmonary abnormalities were classified into 4 categories (ILD, nodular lesions, AD and other) and 20 lesions such as ground-glass opacity, reticular pattern, bronchiolitis and bronchiectasis and were recorded in their existence and distribution. Based on the characteristics, clinical features and HR-CT findings, we identified risk factors for newly developing / worsening pulmonary abnormalities which were defined by HRCT findings. For this purpose, logistic regression analysis was conducted.

Results: Subjects were M/F; 64/144, mean age; 59.2 year-old and disease duration; 13.1 years. Pulmonary lesions were found in 146 (70.2%) of RA patients before bDMARDs. (ILD; 38.9%, nodular lesions; 21.6%. AD; 55.3%). AD was commonly found as a common pulmonary lesion in the most of patients with pulmonary abnormalities.

Sequential CT was conducted, the reasons for which were respiratory symptom such as cough in 40% and regular follow up of chest abnormalities in 60%. The intervals of the CT scans are 3.26±2.61 years. Newly developing/worsening pulmonary abnormalities were observed in 13.8 /100 person years. The incidence of ILD, nodular lesions, and AD were 8.5, 2.9 and 6.5 /100 person years, respectively.

The risk factors for newly developing / worsening pulmonary abnormalities were older age, older onset, and pre-existing pulmonary diseases（Odds 5.31), particularly AD（Odds 2.41). MTX was the protective factor (Odds 0.53). Multiple logistic analysis has shown that AD was the only an independent risk factor for newly developing/worsening pulmonary abnormalities(Odds 2.51).

Nine patients died of respiratory failure. The risk factors for fatal respiratory failure were pre-existing pulmonary lesions which were ILD (Odds 28.5) and AD (Odds 8.5), but not nodular lesions. Moreover, newly developing/ worsening ILD was the risk factor (Odds 12.3), but not emerging nodular lesions or AD were. In addition, sero-positivity or treatment were not identified as risk factors.

Conclusion: Newly emerging/ worsening pulmonary abnormalities were observed in approximately 14/100 person-years under bDMARDs. The patients with pre-existing pulmonary lesions, particularly ILD and AD should be observed carefully for newly emerging/ worsening ILD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-risk-factors-of-newly-developingworsening-pulmonary-abnormalities-in-rheumatoid-arthritis/