Abstract：
OBJECTIVE: Interstitial lung disease (ILD) is a common extra-articular manifestation of rheumatoid arthritis (RA) and is associated with high mortality, especially in progressive ILD. We aimed to identify predictors of disease progression in the early stages of ILD in a large sample of patients with RA.
METHODS: The medical records of 201 RA-ILD patients were retrospectively analyzed. According to changes in their pulmonary function tests, patients were divided into progressive disease and stable disease groups. Data were collected on clinical characteristics, laboratory findings, chest high-resolution computed tomography, and therapeutic agents. Univariate and multivariate analyses were performed to identify predictors of ILD progression.
RESULTS: During a median follow up of 38 months, 105 (52.5%) patients were diagnosed with progressive ILD. These patients were mostly male, past or present smokers (P = 0.028, P = 0.021, respectively). Higher Health Assessment Questionnaire-Disability Index score and higher Disease Activity Score in 28 joints with erythrocyte sedimentation rate (DAS28-ESR) were observed in the ILD progression group (P = 0.003, P < 0.001, respectively). There were no significant differences in baseline respiratory symptoms, pulmonary function, or laboratory features. Multivariate analysis indicated that high DAS28-ESR, definite usual interstitial pneumonia pattern, fibrosis score, and less use of cyclophosphamide were independent risk factors for RA-ILD progression. Fifteen (7.46%) patients died during the follow up, and the most frequent cause of death was lung infection.
CONCLUSIONS: Our results suggested that high disease activity, definite usual interstitial pneumonia pattern, fibrosis score, and less use of cyclophosphamide at the onset of ILD may indicate the progression of ILD in RA patients.
METHODS: The medical records of 201 RA-ILD patients were retrospectively analyzed. According to changes in their pulmonary function tests, patients were divided into progressive disease and stable disease groups. Data were collected on clinical characteristics, laboratory findings, chest high-resolution computed tomography, and therapeutic agents. Univariate and multivariate analyses were performed to identify predictors of ILD progression.
RESULTS: During a median follow up of 38 months, 105 (52.5%) patients were diagnosed with progressive ILD. These patients were mostly male, past or present smokers (P = 0.028, P = 0.021, respectively). Higher Health Assessment Questionnaire-Disability Index score and higher Disease Activity Score in 28 joints with erythrocyte sedimentation rate (DAS28-ESR) were observed in the ILD progression group (P = 0.003, P < 0.001, respectively). There were no significant differences in baseline respiratory symptoms, pulmonary function, or laboratory features. Multivariate analysis indicated that high DAS28-ESR, definite usual interstitial pneumonia pattern, fibrosis score, and less use of cyclophosphamide were independent risk factors for RA-ILD progression. Fifteen (7.46%) patients died during the follow up, and the most frequent cause of death was lung infection.
CONCLUSIONS: Our results suggested that high disease activity, definite usual interstitial pneumonia pattern, fibrosis score, and less use of cyclophosphamide at the onset of ILD may indicate the progression of ILD in RA patients.
摘要：
目的：间质性肺病（ILD）是类风湿性关节炎（RA）的常见关节外表现，并与高死亡率相关，尤其是渐进式ILD。我们的目的是在大量RA患者样本中确定ILD早期疾病进展的预测因子。
方法：对201例RA-ILD患者的病历资料进行回顾性分析。根据他们肺功能测试的变化，患者分为疾病进展组和疾病稳定组。收集有关临床特征的数据，实验室发现,胸部高分辨率计算机断层扫描，和治疗剂。进行单变量和多变量分析以确定ILD进展的预测因子。
结果：在38个月的中位随访中，105例（52.5%）患者被诊断为进行性ILD。这些病人大多是男性,过去或现在的吸烟者（分别为P=0.028，P=0.021）。在ILD进展组中，28个关节的健康评估问卷-残疾指数评分较高，而红细胞沉降率（DAS28-ESR）的疾病活动评分较高（分别为P=0.003，P<0.001）。基线呼吸道症状没有显着差异，肺功能,或实验室功能。多变量分析表明，高DAS28-ESR，明确的常见间质性肺炎模式，纤维化评分，和较少使用环磷酰胺是RA-ILD进展的独立危险因素.15例(7.46%)患者在随访期间死亡,最常见的死因是肺部感染。
结论：我们的结果表明，高疾病活动性，明确的常见间质性肺炎模式，纤维化评分，在RA患者中,在ILD发作时较少使用环磷酰胺可能提示ILD进展.
方法：对201例RA-ILD患者的病历资料进行回顾性分析。根据他们肺功能测试的变化，患者分为疾病进展组和疾病稳定组。收集有关临床特征的数据，实验室发现,胸部高分辨率计算机断层扫描，和治疗剂。进行单变量和多变量分析以确定ILD进展的预测因子。
结果：在38个月的中位随访中，105例（52.5%）患者被诊断为进行性ILD。这些病人大多是男性,过去或现在的吸烟者（分别为P=0.028，P=0.021）。在ILD进展组中，28个关节的健康评估问卷-残疾指数评分较高，而红细胞沉降率（DAS28-ESR）的疾病活动评分较高（分别为P=0.003，P<0.001）。基线呼吸道症状没有显着差异，肺功能,或实验室功能。多变量分析表明，高DAS28-ESR，明确的常见间质性肺炎模式，纤维化评分，和较少使用环磷酰胺是RA-ILD进展的独立危险因素.15例(7.46%)患者在随访期间死亡,最常见的死因是肺部感染。
结论：我们的结果表明，高疾病活动性，明确的常见间质性肺炎模式，纤维化评分，在RA患者中,在ILD发作时较少使用环磷酰胺可能提示ILD进展.
