Rheumatoid arthritis disease activity predicting incident clinically-apparent RA-associated interstitial lung disease: A prospective cohort study

Jeffrey A Sparks, Xintong He, Jie Huang, Elaine A Fletcher, Alessandra Zaccardelli, H Maura Friedlander, Ritu R Gill, Hiroto Hatabu, Mizuki Nishino, David J Murphy, Christine K Iannaccone, Taysir G Mahmoud, Michelle L Frits, Bing Lu, Ivan O Rosas, Paul F Dellaripa, Michael E Weinblatt, Elizabeth W Karlson, Nancy A Shadick, Tracy J Doyle
Arthritis & Rheumatology 2019 April 5

OBJECTIVE: To evaluate rheumatoid arthritis (RA) disease activity and risk for RA-associated interstitial lung disease (RA-ILD).

METHODS: We investigated disease activity and RA-ILD risk using the Brigham RA Sequential Study (BRASS, 2003-2016). All subjects had RA according to accepted criteria. Disease activity scores using 28 joints (DAS28) and covariate data were measured prospectively at annual study visits. RA-ILD was determined by research review of images from clinically-indicated chest computed tomography scans. We analyzed subjects without RA-ILD at baseline. Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for RA-ILD by time-updated DAS28 categories, adjusting for known RA-ILD risk factors (age, sex, smoking, RA duration, and serologic status). We performed alternative analyses not censoring after missing DAS28 and adjusting for methotrexate/glucocorticoids/bone erosions/rheumatoid nodules.

RESULTS: Among 1,419 participants, mean age was 55.8 years (SD 14.2) and 68.6% were seropositive. We identified 85 incident RA-ILD cases during mean 8.9 years (SD 4.2) of follow-up/subject. Moderate/high disease activity had multivariable HR of 2.22 (95%CI 1.28-3.82) for RA-ILD compared to remission/low. Risk for RA-ILD increased across disease activity categories; multivariable HRs(95%CIs) were: 1.00(reference) for remission, 1.41(0.61-3.28) for low, 2.08(1.06-4.05) for moderate, and 3.48(1.64-7.38) for high (p trend=0.001). For every unit increase in DAS28, RA-ILD risk increased by 35% (95%CI 14-60%). Results were similar in analyses including follow-up after missing DAS28 and adjusting for methotrexate, glucocorticoids, bone erosions, or rheumatoid nodules.

CONCLUSION: Active RA was associated with increased risk for developing RA-ILD. These results suggest that decreasing systemic inflammation may alter the natural history of RA-ILD development. This article is protected by copyright. All rights reserved.


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