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Rheumatoid arthritis-related interstitial lung disease: associations, prognostic factors and physiological and radiological characteristics--a large multicentre UK study.
Rheumatology (Oxford). 2014 Sep; 53(9):1676-82.R

Abstract

OBJECTIVES

The prevalence of interstitial lung disease (ILD) in RA is ∼5%. Previous work identified increasing age, active articular disease and articular damage as risk factors for RA-associated ILD (RA-ILD). The roles of high-resolution CT (HRCT) and lung function testing in defining the nature and extent of pulmonary involvement have recently been explored. This study is the first to examine predictive and prognostic factors for the development of RA-ILD and to report on the physiological and radiological characteristics of the condition from a large multicentre UK network.

METHODS

We collected data from centres across the UK on patients with both RA and ILD (proved on HRCT) diagnosed over a 25-year period from 1987 to 2012 using a standard pro forma. Potential predictors of RA-ILD were analysed. Baseline lung function data were recorded and related to HRCT findings. We analysed HRCT for subtype and extent of lung involved and examined the relationship between these and both all-cause and pulmonary mortality. We compared our results with case controls matched for age and gender using computer-generated selection from the RA population from one contributing centre.

RESULTS

A total of 230 patients were identified from across the UK with proven RA-ILD diagnosed over 25 years. Median age at diagnosis was 64 years and the male:female ratio was 1:1.09. Univariate analysis showed anti-CCP antibody titres to be the single most strongly associated predictor of RA-ILD. Male gender, age at onset, smoking and RF were all independently associated with RA-ILD on multivariate analysis. Vital capacity (VC) was preserved in limited disease but reduced in extensive disease, while gas transfer was reduced in both. Usual interstitial pneumonia (UIP) was the most common subtype on HRCT and both this and extensive disease were associated with increased all-cause mortality.

CONCLUSION

This is the largest study of RA-ILD in the UK. Anti-CCP antibodies were strongly associated with RA-ILD in both sexes. Smoking was strongly associated with ILD in males, which may explain the higher frequency of RA-ILD in men. The predominant HRCT pattern was UIP and most patients had limited disease at presentation. The presence of UIP and extensive disease are associated with increased mortality. Baseline gas transfer is a useful screening tool for ILD, while the preservation of VC at baseline might predict limited disease on HRCT.

Authors+Show Affiliations

Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK. clive.kelly@ghnt.nhs.uk.Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK.Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK.Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK.Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK.Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK.Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK.Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK.Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK.Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK.Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

24758887

Citation

Kelly, Clive A., et al. "Rheumatoid Arthritis-related Interstitial Lung Disease: Associations, Prognostic Factors and Physiological and Radiological Characteristics--a Large Multicentre UK Study." Rheumatology (Oxford, England), vol. 53, no. 9, 2014, pp. 1676-82.
Kelly CA, Saravanan V, Nisar M, et al. Rheumatoid arthritis-related interstitial lung disease: associations, prognostic factors and physiological and radiological characteristics--a large multicentre UK study. Rheumatology (Oxford). 2014;53(9):1676-82.
Kelly, C. A., Saravanan, V., Nisar, M., Arthanari, S., Woodhead, F. A., Price-Forbes, A. N., Dawson, J., Sathi, N., Ahmad, Y., Koduri, G., & Young, A. (2014). Rheumatoid arthritis-related interstitial lung disease: associations, prognostic factors and physiological and radiological characteristics--a large multicentre UK study. Rheumatology (Oxford, England), 53(9), 1676-82. https://doi.org/10.1093/rheumatology/keu165
Kelly CA, et al. Rheumatoid Arthritis-related Interstitial Lung Disease: Associations, Prognostic Factors and Physiological and Radiological Characteristics--a Large Multicentre UK Study. Rheumatology (Oxford). 2014;53(9):1676-82. PubMed PMID: 24758887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rheumatoid arthritis-related interstitial lung disease: associations, prognostic factors and physiological and radiological characteristics--a large multicentre UK study. AU - Kelly,Clive A, AU - Saravanan,Vadivelu, AU - Nisar,Mohamed, AU - Arthanari,Subha, AU - Woodhead,Felix A, AU - Price-Forbes,Alec N, AU - Dawson,Julie, AU - Sathi,Navtej, AU - Ahmad,Yasmeen, AU - Koduri,Gouri, AU - Young,Adam, AU - ,, Y1 - 2014/04/23/ PY - 2014/4/25/entrez PY - 2014/4/25/pubmed PY - 2014/12/23/medline KW - high-resolution computed tomography KW - lung disease KW - prognosis KW - pulmonary function KW - rheumatoid arthritis KW - risk factors SP - 1676 EP - 82 JF - Rheumatology (Oxford, England) JO - Rheumatology (Oxford) VL - 53 IS - 9 N2 - OBJECTIVES: The prevalence of interstitial lung disease (ILD) in RA is ∼5%. Previous work identified increasing age, active articular disease and articular damage as risk factors for RA-associated ILD (RA-ILD). The roles of high-resolution CT (HRCT) and lung function testing in defining the nature and extent of pulmonary involvement have recently been explored. This study is the first to examine predictive and prognostic factors for the development of RA-ILD and to report on the physiological and radiological characteristics of the condition from a large multicentre UK network. METHODS: We collected data from centres across the UK on patients with both RA and ILD (proved on HRCT) diagnosed over a 25-year period from 1987 to 2012 using a standard pro forma. Potential predictors of RA-ILD were analysed. Baseline lung function data were recorded and related to HRCT findings. We analysed HRCT for subtype and extent of lung involved and examined the relationship between these and both all-cause and pulmonary mortality. We compared our results with case controls matched for age and gender using computer-generated selection from the RA population from one contributing centre. RESULTS: A total of 230 patients were identified from across the UK with proven RA-ILD diagnosed over 25 years. Median age at diagnosis was 64 years and the male:female ratio was 1:1.09. Univariate analysis showed anti-CCP antibody titres to be the single most strongly associated predictor of RA-ILD. Male gender, age at onset, smoking and RF were all independently associated with RA-ILD on multivariate analysis. Vital capacity (VC) was preserved in limited disease but reduced in extensive disease, while gas transfer was reduced in both. Usual interstitial pneumonia (UIP) was the most common subtype on HRCT and both this and extensive disease were associated with increased all-cause mortality. CONCLUSION: This is the largest study of RA-ILD in the UK. Anti-CCP antibodies were strongly associated with RA-ILD in both sexes. Smoking was strongly associated with ILD in males, which may explain the higher frequency of RA-ILD in men. The predominant HRCT pattern was UIP and most patients had limited disease at presentation. The presence of UIP and extensive disease are associated with increased mortality. Baseline gas transfer is a useful screening tool for ILD, while the preservation of VC at baseline might predict limited disease on HRCT. SN - 1462-0332 UR - https://www.unboundmedicine.com/medline/citation/24758887/Rheumatoid_arthritis_related_interstitial_lung_disease:_associations_prognostic_factors_and_physiological_and_radiological_characteristics__a_large_multicentre_UK_study_ L2 - https://academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/keu165 DB - PRIME DP - Unbound Medicine ER -