Interstitial lung disease has a poor prognosis in rheumatoid arthritis: results from an inception cohort
Open Access
- 11 March 2010
- journal article
- research article
- Published by Oxford University Press (OUP) in Rheumatology
- Vol. 49 (8), 1483-1489
- https://doi.org/10.1093/rheumatology/keq035
Abstract
Objectives. Pulmonary complications of RA are well described. Although some are benign, interstitial lung disease (ILD) has a poor prognosis. Few RA inception cohorts have reported the natural history of ILD related to RA (RA-ILD). We examine its incidence, outcome and prognostic indicators. Methods. Extra-articular features and comorbidity have been recorded yearly in a well-established inception cohort of RA with a 20-year follow-up. Standard clinical, laboratory and radiological measures of RA were recorded at baseline and yearly. Details of deaths were provided by a national central register. Results. Out of 1460 patients, 52 developed RA-ILD, half either at baseline or within 3 years of onset. The annualized incidence was 4.1/1000 (95% CI 3.0, 5.4) and the 15-year cumulative incidence 62.9/1000 (95% CI 43.0, 91.7). Incidence of RA-ILD was associated with older age, raised baseline ESR and HAQ. Evidence to implicate any drug effect (e.g. MTX) was lacking. Of these patients, 39 died, attributed to RA-ILD in 28. Median survival following diagnosis of RA-ILD was 3 years. Conclusions. RA-ILD is an important and early feature of RA. It is related to disease activity and has a poor prognosis. Further studies are required to determine whether screening for pulmonary disease would identify these patients at an earlier stage.Keywords
This publication has 36 references indexed in Scilit:
- Extra-articular manifestations and complications of rheumatoid arthritisBest Practice & Research Clinical Rheumatology, 2007
- Serious infections with antirheumatic therapy: are biologicals worse?Annals Of The Rheumatic Diseases, 2006
- Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: Associations with prednisone, disease‐modifying antirheumatic drugs, and anti–tumor necrosis factor therapyArthritis & Rheumatism, 2006
- Genetics of fibrosing lung diseasesEuropean Respiratory Journal, 2005
- Incidence of interstitial lung diseases in the south of Spain 1998–2000: The RENIA studyEuropean Journal of Epidemiology, 2003
- American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial PneumoniasAmerican Journal of Respiratory and Critical Care Medicine, 2002
- A Mutation in the Surfactant Protein C Gene Associated with Familial Interstitial Lung DiseaseNew England Journal of Medicine, 2001
- Cigarette smoking: a risk factor for idiopathic pulmonary fibrosis.American Journal of Respiratory and Critical Care Medicine, 1997
- PULMONARY FUNCTION IN RHEUMATOID ARTHRITIS TREATED WITH LOW-DOSE METHOTREXATE: A LONGITUDINAL STUDYRheumatology, 1996
- What causes cryptogenic fibrosing alveolitis? A case-control study of environmental exposure to dust.BMJ, 1990