Interstitial lung disease risk linked to rheumatoid arthritis disease severity
medwireNews: Moderate-to-high rheumatoid arthritis (RA) disease activity is associated with a twofold increased risk for associated interstitial lung disease (ILD), compared with remission or low disease activity, study findings show.
This suggests that “decreasing systemic inflammation by treating RA signs or symptoms may delay or even prevent RA-ILD onset,” presenting author Jeffrey Sparks, from Brigham and Women’s Hospital, Boston, Massachusetts, USA, said at the 2018 ACR/ARHP Annual Meeting in Chicago, Illinois, USA.
In all, 1419 patients from the Brigham Rheumatoid Arthritis Sequential Study (BRASS) registry aged an average of approximately 55 years and with a median duration of RA of around 9 years participated in the trial. None of the patients had clinically apparent ILD at the start of the study.
Over a total of 12,650 person–years of follow-up, there were 85 (6.0%) incident RA-ILD outcomes, detected on computed tomography chest scans.
The researchers note that 35 out of 792 patients with high-to-moderate RA disease activity, as measured according to DAS28-CRP criteria, had incident RA-ILD outcomes over 2509 person–years of follow-up.
This rate was 2.22-fold greater than that seen among the 627 patients in remission or with low RA disease activity, at 26 cases over 5459 person–years, after accounting for other known ILD risk factors such as age, sex, smoking, RA duration, and serostatus.
Patients with high RA disease activity had the greatest risk increase for ILD relative to patients in remission, at a significant 3.48-fold, compared with a significant 2.08-fold increase among those with moderate disease activity, after accounting for variables including age, RA duration, and serostatus.
Indeed, Sparks and team estimated that the risk for ILD increased a significant 35% with each unit increase in DAS28-CRP.
Spark noted that the findings were “robust” to different definitions of DAS28 and censoring and follow-up analysis strategies.
Spark said that the next steps would be “to look at the role of particular DMARDs on RA-ILD pathogenesis” and for clinical trials to study the effects of treat-to-target strategies on RA-ILD outcome.
By Lucy Piper
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