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Rheumatoid Arthritis Disease Activity Predicting Incident Clinically Apparent Rheumatoid Arthritis–Associated Interstitial Lung Disease: A Prospective Cohort Study
Author(s) -
Sparks Jeffrey A.,
He Xintong,
Huang Jie,
Fletcher Elaine A.,
Zaccardelli Alessandra,
Friedlander H. Maura,
Gill Ritu R.,
Hatabu Hiroto,
Nishino Mizuki,
Murphy David J.,
Iannaccone Christine K.,
Mahmoud Taysir G.,
Frits Michelle L.,
Lu Bing,
Rosas Ivan O.,
Dellaripa Paul F.,
Weinblatt Michael E.,
Karlson Elizabeth W.,
Shadick Nancy A.,
Doyle Tracy J.
Publication year - 2019
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.40904
Subject(s) - medicine , rheumatoid arthritis , interstitial lung disease , rheumatoid factor , hazard ratio , proportional hazards model , rheumatoid nodule , prospective cohort study , cohort , rheumatology , confidence interval , gastroenterology , lung
Objective To evaluate rheumatoid arthritis ( RA ) disease activity and risk of RA ‐associated interstitial lung disease (RA‐ILD). Methods We investigated disease activity and risk of RA‐ILD using the Brigham RA Sequential Study ( BRASS , 2003–2016). All patients were diagnosed as having RA according to accepted criteria. Disease Activity Scores in 28 joints ( DAS 28) and covariate data were measured prospectively at annual study visits. Diagnosis of RA‐ILD was determined by review of images from clinically indicated chest computed tomography scans. We analyzed patients without RA‐ILD at baseline. We used Cox regression to estimate hazard ratios ( HR s) and 95% confidence intervals ( CI s) for RA‐ILD, using annually updated DAS 28 data, with adjustment for known RA‐ILD risk factors (age, sex, smoking status, RA duration, and serologic status). We performed alternative analyses that did not censor at the time of missing DAS 28 data and included adjustment for use of methotrexate, use of glucocorticoids, presence of bone erosions, and presence of rheumatoid nodules. Results Among 1,419 participants, the mean ± SD age was 55.8 ± 14.2 years, and 68.6% were seropositive for either cyclic citrullinated peptide or rheumatoid factor. We identified 85 incident cases of RA‐ILD during a mean ± SD follow‐up duration of 8.9 ± 4.2 years per patient. The moderate/high disease activity group had a multivariable HR of 2.22 (95% CI 1.28–3.82) for RA‐ILD compared to the remission/low disease activity group. Risk of RA‐ILD increased across disease activity categories: multivariable HR 1.00 (reference) for remission, 1.41 (95% CI 0.61–3.28) for low disease activity, 2.08 (95% CI 1.06–4.05) for moderate disease activity, and 3.48 (95% CI 1.64–7.38) for high disease activity ( P for trend = 0.001). For each unit increase in the DAS 28, the risk of RA‐ILD increased by 35% (95% CI 14–60%). Results were similar in analyses that included follow‐up for missing DAS 28 data and with adjustment for use of methotrexate, use of glucocorticoids, presence of bone erosions, or presence of rheumatoid nodules. Conclusion Active articular RA was associated with an increased risk of developing RA‐ILD. These results suggest that decreasing systemic inflammation may alter the natural history of RA‐ILD development.