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Fibrosing interstitial pneumonia predicts survival in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD).
Respir Med. 2013 Aug; 107(8):1247-52.RM

Abstract

BACKGROUND

Rheumatoid arthritis (RA) is a systemic autoimmune disorder with a variety of extra-articular manifestations. The lung is a common target and diffuse parenchymal lung disease can appear as any of the patterns found with idiopathic interstitial pneumonia. Controversy exists as to the prognostic significance of these patterns among patients with RA-ILD.

METHODS

We retrospectively identified 48 patients with a diagnosis of RA-ILD confirmed by surgical lung biopsy. The pathology was reviewed by four expert pulmonary pathologists. We examined survival after stratifying on the presence or absence of fibrotic ILD, and contrasted it with a matched idiopathic pulmonary fibrosis (IPF) population. The Cox proportional hazards model was used to identify independent predictors of survival.

RESULTS

The majority of subjects were male smokers with physiologic restriction. A usual interstitial pneumonia (UIP)-pattern was identified in 31% of subjects. Median survival time for the entire cohort was 1360 days. Subjects with fibrotic ILD had worse survival than subjects with non-fibrotic ILD (log rank p = 0.02). There was no difference in survival between UIP-pattern RA-ILD subjects and IPF controls (log rank p = 0.94). Multivariable analysis revealed that age (hazard ratio [HR] = 1.04, p = 0.01) and fibrosis (HR = 2.1, p = 0.02) were independent predictors of mortality.

CONCLUSIONS

Both cellular and fibrosing ILD patterns are common among RA-ILD patients who undergo surgical lung biopsy. These patients have a shortened survival when compared to the general population and all-comers with RA. Age and the presence of a fibrosing interstitial pneumonia predict shortened survival in these patients. Survival in UIP is similar to matched IPF patients.

Authors+Show Affiliations

Autoimmune Lung Center and ILD Program, National Jewish Health, Denver, CO 80206, USA. solomonj@njhealth.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23791462

Citation

Solomon, Joshua J., et al. "Fibrosing Interstitial Pneumonia Predicts Survival in Patients With Rheumatoid Arthritis-associated Interstitial Lung Disease (RA-ILD)." Respiratory Medicine, vol. 107, no. 8, 2013, pp. 1247-52.
Solomon JJ, Ryu JH, Tazelaar HD, et al. Fibrosing interstitial pneumonia predicts survival in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Respir Med. 2013;107(8):1247-52.
Solomon, J. J., Ryu, J. H., Tazelaar, H. D., Myers, J. L., Tuder, R., Cool, C. D., Curran-Everett, D., Fischer, A., Swigris, J. J., & Brown, K. K. (2013). Fibrosing interstitial pneumonia predicts survival in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Respiratory Medicine, 107(8), 1247-52. https://doi.org/10.1016/j.rmed.2013.05.002
Solomon JJ, et al. Fibrosing Interstitial Pneumonia Predicts Survival in Patients With Rheumatoid Arthritis-associated Interstitial Lung Disease (RA-ILD). Respir Med. 2013;107(8):1247-52. PubMed PMID: 23791462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fibrosing interstitial pneumonia predicts survival in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD). AU - Solomon,Joshua J, AU - Ryu,Jay H, AU - Tazelaar,Henry D, AU - Myers,Jeffrey L, AU - Tuder,Rubin, AU - Cool,Carlyne D, AU - Curran-Everett,Douglas, AU - Fischer,Aryeh, AU - Swigris,Jeffrey J, AU - Brown,Kevin K, Y1 - 2013/06/19/ PY - 2013/02/07/received PY - 2013/05/08/revised PY - 2013/05/13/accepted PY - 2013/6/25/entrez PY - 2013/6/25/pubmed PY - 2014/2/19/medline KW - Interstitial lung disease KW - Nonspecific interstitial pneumonia KW - Rheumatoid arthritis KW - Usual interstitial pneumonia SP - 1247 EP - 52 JF - Respiratory medicine JO - Respir Med VL - 107 IS - 8 N2 - BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune disorder with a variety of extra-articular manifestations. The lung is a common target and diffuse parenchymal lung disease can appear as any of the patterns found with idiopathic interstitial pneumonia. Controversy exists as to the prognostic significance of these patterns among patients with RA-ILD. METHODS: We retrospectively identified 48 patients with a diagnosis of RA-ILD confirmed by surgical lung biopsy. The pathology was reviewed by four expert pulmonary pathologists. We examined survival after stratifying on the presence or absence of fibrotic ILD, and contrasted it with a matched idiopathic pulmonary fibrosis (IPF) population. The Cox proportional hazards model was used to identify independent predictors of survival. RESULTS: The majority of subjects were male smokers with physiologic restriction. A usual interstitial pneumonia (UIP)-pattern was identified in 31% of subjects. Median survival time for the entire cohort was 1360 days. Subjects with fibrotic ILD had worse survival than subjects with non-fibrotic ILD (log rank p = 0.02). There was no difference in survival between UIP-pattern RA-ILD subjects and IPF controls (log rank p = 0.94). Multivariable analysis revealed that age (hazard ratio [HR] = 1.04, p = 0.01) and fibrosis (HR = 2.1, p = 0.02) were independent predictors of mortality. CONCLUSIONS: Both cellular and fibrosing ILD patterns are common among RA-ILD patients who undergo surgical lung biopsy. These patients have a shortened survival when compared to the general population and all-comers with RA. Age and the presence of a fibrosing interstitial pneumonia predict shortened survival in these patients. Survival in UIP is similar to matched IPF patients. SN - 1532-3064 UR - https://www.unboundmedicine.com/medline/citation/23791462/Fibrosing_interstitial_pneumonia_predicts_survival_in_patients_with_rheumatoid_arthritis_associated_interstitial_lung_disease__RA_ILD__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0954-6111(13)00174-1 DB - PRIME DP - Unbound Medicine ER -