Abstract：
The clinical heterogeneity of the progression of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is high, and there is a lack of consensus on the clinical relevance and medical protocols. The purpose of this study is to explore the impact of clinical characteristics, new biomarkers and treatment options on the prognosis of RA-ILD patients and to explore whether these factors can predict the progression and death of these patients.
We retrospectively collected case data on RA-ILD patients who visited or were admitted to Changhai Hospital between October 2010 and September 2021. We followed up and finally included 75 patients. The main outcome indicator of disease progression was pulmonary functional impairment, which was assessed by changes of high-resolution computed tomography (HRCT) score or pulmonary function test before and after treatment. The demographics, clinical characteristics, laboratory tests, and treatment plans of RA-ILD patients in the progressive and stable groups were compared and analyzed. Clinically relevant variables were identified, and the incidence of pulmonary dysfunction and adverse events was recorded. Cox regression analysis was used to determine factors related to the progression of ILD.
The mean age of RA-ILD onset was 64.0 years (SD 10.3), and 53 (70.7%) patients were female. Thirty-two (42.7%) patients had lung dysfunction, who were classified as the progressive group, and 13 (40.6%) of them died. In univariate analyses, male, smoking, high HRCT scores at baseline, RF-IgA>200 RU/ml, diffusing capacity of the lungs for carbon monoxide (DLCO), and usual interstitial pneumonia (UIP) pattern were significant risk factors for disease progression; while use of Leflunomide (LEF) was associated with better prognosis. The multivariate analysis revealed that RF-IgA>200 RU/ml (hazard ratio [HR] 3.17 [95% confidence interval (CI) 1.29, 7.81], P = 0.012), UIP pattern (HR 3.94 [95% CI 1.68, 9.26], P = 0.002), and male (HR 2.52 [95% CI 1.16, 5.46], P = 0.019) were significantly correlated with unfavorable outcomes in patients with RA-ILD. LEF (HR 0.25 [95% CI 0.10, 0.61], P = 0.002) was related to a better prognosis. However, it might be related to investigating medications changes after baseline.
Our data suggests that male, UIP pattern, and increased RF-IgA may be potential predicting factors for poor prognosis of RA-ILD patients. We report a significant association between high titer of RF-IgA at baseline and RA-ILD progression for the first time, which might be a potentially important biomarker for the prognosis of RA-ILD.
We retrospectively collected case data on RA-ILD patients who visited or were admitted to Changhai Hospital between October 2010 and September 2021. We followed up and finally included 75 patients. The main outcome indicator of disease progression was pulmonary functional impairment, which was assessed by changes of high-resolution computed tomography (HRCT) score or pulmonary function test before and after treatment. The demographics, clinical characteristics, laboratory tests, and treatment plans of RA-ILD patients in the progressive and stable groups were compared and analyzed. Clinically relevant variables were identified, and the incidence of pulmonary dysfunction and adverse events was recorded. Cox regression analysis was used to determine factors related to the progression of ILD.
The mean age of RA-ILD onset was 64.0 years (SD 10.3), and 53 (70.7%) patients were female. Thirty-two (42.7%) patients had lung dysfunction, who were classified as the progressive group, and 13 (40.6%) of them died. In univariate analyses, male, smoking, high HRCT scores at baseline, RF-IgA>200 RU/ml, diffusing capacity of the lungs for carbon monoxide (DLCO), and usual interstitial pneumonia (UIP) pattern were significant risk factors for disease progression; while use of Leflunomide (LEF) was associated with better prognosis. The multivariate analysis revealed that RF-IgA>200 RU/ml (hazard ratio [HR] 3.17 [95% confidence interval (CI) 1.29, 7.81], P = 0.012), UIP pattern (HR 3.94 [95% CI 1.68, 9.26], P = 0.002), and male (HR 2.52 [95% CI 1.16, 5.46], P = 0.019) were significantly correlated with unfavorable outcomes in patients with RA-ILD. LEF (HR 0.25 [95% CI 0.10, 0.61], P = 0.002) was related to a better prognosis. However, it might be related to investigating medications changes after baseline.
Our data suggests that male, UIP pattern, and increased RF-IgA may be potential predicting factors for poor prognosis of RA-ILD patients. We report a significant association between high titer of RF-IgA at baseline and RA-ILD progression for the first time, which might be a potentially important biomarker for the prognosis of RA-ILD.
摘要：
类风湿关节炎相关间质性肺病（RA-ILD）进展的临床异质性很高，在临床相关性和医疗方案上缺乏共识。本研究的目的是探讨影响临床特点,新的生物标志物和治疗方案对RA-ILD患者预后的影响，并探讨这些因素是否可以预测这些患者的进展和死亡。
我们回顾性收集了2010年10月至2021年9月在长海医院就诊或入院的RA-ILD患者的病例资料。我们进行了随访，最终纳入了75名患者。疾病进展的主要结果指标是肺功能损害，通过治疗前后高分辨率计算机断层扫描（HRCT）评分或肺功能检查的变化进行评估。人口统计，临床特征,实验室测试,对进展组和稳定组的RA-ILD患者的治疗方案进行比较分析。确定了临床相关变量，并记录肺功能障碍和不良事件的发生率。Cox回归分析用于确定与ILD进展相关的因素。
RA-ILD发病的平均年龄为64.0岁（SD10.3），53例（70.7%）患者为女性。32例(42.7%)患者有肺功能障碍,他们被归类为进步组，13人(40.6%)死亡。在单变量分析中，男性,吸烟,基线时HRCT得分高，RF-IgA>200RU/ml,肺对一氧化碳（DLCO）的扩散能力，和常规间质性肺炎(UIP)模式是疾病进展的重要危险因素;而使用来氟米特(LEF)与更好的预后相关.多变量分析显示RF-IgA>200RU/ml（风险比[HR]3.17[95％置信区间（CI）1.29，7.81]，P=0.012),UIP模式（HR3.94[95%CI1.68，9.26]，P=0.002),和男性（HR2.52[95%CI1.16，5.46]，P=0.019）与RA-ILD患者的不良结局显着相关。LEF（HR0.25[95%CI0.10，0.61]，P=0.002）与较好的预后有关。然而,这可能与基线后调查用药变化有关.
我们的数据表明男性,UIP模式,RF-IgA升高可能是RA-ILD患者预后不良的潜在预测因素。我们首次报道了基线RF-IgA高滴度与RA-ILD进展之间的显著关联，这可能是RA-ILD预后的潜在重要生物标志物。
我们回顾性收集了2010年10月至2021年9月在长海医院就诊或入院的RA-ILD患者的病例资料。我们进行了随访，最终纳入了75名患者。疾病进展的主要结果指标是肺功能损害，通过治疗前后高分辨率计算机断层扫描（HRCT）评分或肺功能检查的变化进行评估。人口统计，临床特征,实验室测试,对进展组和稳定组的RA-ILD患者的治疗方案进行比较分析。确定了临床相关变量，并记录肺功能障碍和不良事件的发生率。Cox回归分析用于确定与ILD进展相关的因素。
RA-ILD发病的平均年龄为64.0岁（SD10.3），53例（70.7%）患者为女性。32例(42.7%)患者有肺功能障碍,他们被归类为进步组，13人(40.6%)死亡。在单变量分析中，男性,吸烟,基线时HRCT得分高，RF-IgA>200RU/ml,肺对一氧化碳（DLCO）的扩散能力，和常规间质性肺炎(UIP)模式是疾病进展的重要危险因素;而使用来氟米特(LEF)与更好的预后相关.多变量分析显示RF-IgA>200RU/ml（风险比[HR]3.17[95％置信区间（CI）1.29，7.81]，P=0.012),UIP模式（HR3.94[95%CI1.68，9.26]，P=0.002),和男性（HR2.52[95%CI1.16，5.46]，P=0.019）与RA-ILD患者的不良结局显着相关。LEF（HR0.25[95%CI0.10，0.61]，P=0.002）与较好的预后有关。然而,这可能与基线后调查用药变化有关.
我们的数据表明男性,UIP模式,RF-IgA升高可能是RA-ILD患者预后不良的潜在预测因素。我们首次报道了基线RF-IgA高滴度与RA-ILD进展之间的显著关联，这可能是RA-ILD预后的潜在重要生物标志物。
