medwireNews: Researchers have identified a number of factors predicting mortality risk in people with rheumatoid arthritis (RA)-associated interstitial lung disease (ILD), including certain comorbidities, age, and corticosteroid use.
The study included 32,289 people with RA who were included in the Taiwanese National Health Insurance Research Database in 1997–2013, of whom 214 developed RA-ILD.
In a propensity score-matched analysis involving 155 patients with ILD and 155 without, ILD was associated with a significant 4.38-fold increased mortality risk. In all, 27.7% of people with RA-ILD died during 578 person–years of follow-up, compared with 13.6% of people in the non-ILD group during 720 person–years of follow-up.
Among the 214 patients with RA-ILD, comorbid chronic obstructive pulmonary disease (COPD) and diabetes with end-organ damage were both significantly associated with an increased risk for mortality, with hazard ratios of 2.12 and 33.85, respectively, on multivariable analysis. Older age and higher daily prednisolone-equivalent dose were also significantly associated with mortality risk.
Hsin-Hua Chen (Taichung Veterans General Hospital, Taiwan) and team say that these findings highlight the need for “[m]ore judicious use of steroids among elderly patients with RA-ILD,” as well as “[s]creening for comorbidities of COPD and [diabetes] with end-organ damage.”
They conclude in RMD Open that further research should “study the pathophysiology link between [diabetes] and RA-ILD as well as the effect of RA treatments on RA-ILD progression and mortality.”
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