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Respiratory medicine
Research
Acute exacerbation in rheumatoid arthritis-associated interstitial lung disease: a retrospective case control study
  1. Hironao Hozumi1,
  2. Yutaro Nakamura1,
  3. Takeshi Johkoh2,
  4. Hiromitsu Sumikawa3,
  5. Thomas V Colby4,
  6. Masato Kono1,
  7. Dai Hashimoto1,
  8. Noriyuki Enomoto1,
  9. Tomoyuki Fujisawa1,
  10. Naoki Inui1,
  11. Takafumi Suda1,
  12. Kingo Chida1
  1. 1Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
  2. 2Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami-City, Hyogo, Japan
  3. 3Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
  4. 4Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
  1. Correspondence to Dr Yutaro Nakamura; nakayuta{at}hama-med.ac.jp

Abstract

Objectives To investigate the risk factors and prognosis associated with acute exacerbation (AE) in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD).

Design A retrospective case–control study.

Setting A single academic hospital.

Participants 51 consecutive patients diagnosed with RA-ILD between 1995 and 2012. All patients fulfilled the diagnostic criteria of the American College of Rheumatology for RA. ILD was diagnosed on the basis of clinical presentation, pulmonary function tests, high-resolution CT (HRCT) findings and lung biopsy findings.

Main outcome measures Overall survival and cumulative AE incidence were analysed using Kaplan-Meier method. Cox hazards analysis was used to determine significant variables associated with AE occurrence and survival status.

Results A total of 11 patients (22%) developed AE, with an overall 1-year incidence of 2.8%. Univariate analysis revealed that older age at ILD diagnosis (HR 1.11; 95% CI 1.02 to 1.21; p=0.01), usual interstitial pneumonia (UIP) pattern on HRCT (HR 1.95; 95% CI 1.07 to 3.63; p=0.03) and methotrexate usage (HR 3.04; 95% CI 1.62 to 6.02; p=0.001) were associated with AE. Of 11 patients who developed AE during observation period, 7 (64%) died of initial AE. In survival, AE was a prognostic factor for poor outcome (HR 2.47; 95% CI 1.39 to 4.56; p=0.003).

Conclusions In patients with RA-ILD, older age at ILD diagnosis, UIP pattern on HRCT and methotrexate usage are associated with the development of AE. Furthermore, AE has a serious impact on their survival.

  • Rheumatology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/bmjopen-2013-003132

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