Acute Respiratory Deterioration in Rheumatoid Arthritis-Associated Interstitial Lung Disease,Chest

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Acute Respiratory Deterioration in Rheumatoid Arthritis-Associated Interstitial Lung Disease
Chest ( IF 9.5 ) Pub Date : 2022-01-12 , DOI: 10.1016/j.chest.2022.01.007
Byoung Soo Kwon ₁ , Ho Young Lee ₂ , Jooae Choe ₃ , Eun Jin Chae ₃ , Seokchan Hong ₄ , Jin Woo Song ₅

Affiliation

Background

Interstitial lung disease (ILD) is associated with increased morbidity and mortality in rheumatoid arthritis (RA). Moreover, acute exacerbation (AE) is a devastating complication of RA plus ILD. However, few data on AE in RA-associated ILD are available.

Research Question

What are the incidence, risk factors, and outcomes of AE in patients with RA-associated ILD?

Study Design and Methods

The clinical data of 310 patients with RA-associated ILD were analyzed retrospectively. AE was defined as the acute worsening of dyspnea typically within 30 days with new bilateral lung infiltration, which was based on a 2016 report by an international working group.

Results

The mean age of the participants was 61.9 years, and 56.2% of them were women. During follow-up (median, 47.7 months), AE occurred in 87 patients (28.1%). The 1-year, 3-year, and 5-year cumulative incidence rates of AE in patients with RA-associated ILD were 9.2%, 19.8%, and 29.4%, respectively. Ever smoker status, lower FVC, and shorter 6-min walk distance were significant risk factors for the occurrence of AE. In the multivariate Cox analysis adjusted by age, sex, smoking status, lung function, exercise capacity, and high-resolution CT scan pattern, AE was a significant prognostic factor for overall survival (hazard ratio, 2.423; 95% CI, 1.605-3.660; P < .001) in patients with RA-associated ILD. The 30-day and 90-day mortalities after AE were 12.6% and 29.9%, respectively.

Interpretation

Our findings suggest that approximately one-third of patients with RA-associated ILD experience AE and that ever smoker status, and lower lung function and exercise capacity predispose patients to AE. AE significantly affects the overall survival of patients with RA-associated ILD.

中文翻译：

类风湿性关节炎相关间质性肺疾病的急性呼吸系统恶化

背景

间质性肺病 (ILD) 与类风湿性关节炎 (RA) 的发病率和死亡率增加有关。此外，急性加重 (AE) 是 RA 加 ILD 的破坏性并发症。然而，关于 RA 相关 ILD 中 AE 的数据很少。

研究问题

RA 相关 ILD 患者 AE 的发生率、危险因素和结局是什么？

研究设计和方法

回顾性分析310例RA相关ILD患者的临床资料。AE 被定义为呼吸困难的急性恶化，通常在 30 天内伴有新的双侧肺浸润，这是基于一个国际工作组 2016 年的报告。

结果

参与者的平均年龄为 61.9 岁，其中 56.2% 为女性。在随访期间（中位数，47.7 个月），87 名患者（28.1%）发生 AE。RA 相关 ILD 患者 AE 的 1 年、3 年和 5 年累积发生率分别为 9.2%、19.8% 和 29.4%。曾经吸烟者、较低的 FVC 和较短的 6 分钟步行距离是发生 AE 的重要危险因素。在根据年龄、性别、吸烟状况、肺功能、运动能力和高分辨率 CT 扫描模式调整的多变量 Cox 分析中，AE 是总生存期的重要预后因素（风险比，2.423；95% CI，1.605-3.660 ; P < .001) 在 RA 相关 ILD 患者中。AE 后 30 天和 90 天的死亡率分别为 12.6% 和 29.9%。