Common interstitial pneumonia in rheumatoid arthritis is associated with higher mortality

The average age of onset of the condition is 65 years, but there are clinical exceptions that are being studied.

Interstitial lung disease associated with rheumatoid arthritis is associated with reduced survival compared to the general population and the radiographic pattern of pneumonia A common interstitial tumor increases the risk of mortality independently of other factors, according to a Spanish study published in BMC Pulmonary Medicine.

A meta-analysis already suggests that a pattern of pneumonia Usual interstitial appears to be associated with a higher risk of mortality compared to other patterns, but shows marked heterogeneity with variable methodological quality among the included studies.

In this situation, it is relevant to know which factors may influence survival in order to assess the prognosis.

Dr. Francisco Javier Narvaez, spokesperson for the Spanish Society of Rheumatology and a rheumatologist at Bellvitge University Hospital in Barcelona, ​​commented: “Interstitial lung disease associated with rheumatoid arthritis It is a complex clinical situation due to its frequency and potential severity, as well as the difficulty associated with its therapeutic management. For this reason, multidisciplinary follow-up between a rheumatologist and a pulmonologist is recommended in all cases, which will undoubtedly lead to better care for these patients.”

“The development of pulmonary involvement in rheumatoid arthritis is associated with prolonged moderate or high disease activity. For this reason, controlling the activity of rheumatic disease has been shown to prevent and improve the prognosis of lung diseases,” said the rheumatologist.

Mortality and radiographic patterns

The main aim of the study was to analyze the total mortality obtained from the records of the two hospitals.

Radiographic patterns of interstitial lung disease associated with rheumatoid arthritis originally based on high-resolution computed tomography images: pneumonia usual interstitial, non-specific and other (pneumonia organized crypto and others pneumonia idiopathic interstitial). As well as socio-demographic, clinical, laboratory and disease duration characteristics.

High specific mortality rate

Forty-seven patients were enrolled and mean follow-up was 5.3 ± 2.7 years, with a total follow-up of 242 patient-years and a maximum of 12 years. In most patients (89.4%), the diagnosis of rheumatoid arthritis preexisting interstitial lung disease.

The pneumonia Usual interstitial is the most common, followed by nonspecific. After adjusting for confounders, the model of pneumonia the usual interstitial is associated with an increased risk of mortality compared to the pattern of pneumonia non-specific interstitial.

As for the overall standardized mortality, it was 2.57, resulting in an increased mortality in patients compared to the general population. Men and women, as well as those between the ages of 75 and 84, showed increased mortality, while this effect disappeared at 85 years. After stratifying by age and sex, women between the ages of 60 and 75 were the group with the highest standardized mortality rate.

The estimated all-cause mortality rate was 64.3 (39.4 to 104.9) per 1000 patient-years. Patients were death-free up to 1.5 years after diagnosis of interstitial lung disease, with 10% mortality at 3 years, 30% at 6 years, and 50% at 8.3 years after diagnosis. For deaths directly attributable to interstitial lung disease, the specific incidence was 41.4 (22.3 to 76.9), with a median survival of 10.9 years.

Death occurred in 16 patients (34%) in the study during the entire follow-up period. The most common cause is progression of interstitial lung disease, acute exacerbation of the same or pneumonia (62.5%), followed by abdominal sepsis (12.5%), one due to neoplasia, one due to cardiac disease, and one due to cognitive impairment.

Predictors of progression

The main predictors of functional progression of diffuse interstitial lung disease identified were the radiographic pattern of pneumonia interstitial tissue, elevated anti-cyclic citrullinated peptide antibody titers, baseline degree of impaired diffusion lung carbon monoxide (DLCO), greater than or equal to 10% reduction in forced vital capacity during follow-up, extensive lung involvement in high -resolution computed tomography of the chest and elevated serum levels of interleukin-6 and Krebs von den Lungen glycoprotein-6 (KL-6).

All patients were enrolled from the time of diagnosis and were followed up by multidisciplinary autoimmune interstitial lung disease rheumatology units attended by a tandem of pulmonologists and rheumatologists.