ILD Associated With Failed Remission and Adverse Clinical Events Among Patients With RA

Failure to achieve clinical remission and the occurrence of unfavorable clinical events in patients with rheumatoid arthritis (RA) are significantly associated with concomitant interstitial lung disease (ILD), according to study findings published in Rheumatology.

Patients with RA have a 9-fold likelihood of developing concomitant ILD vs the general population. Investigators assessed the impact of concomitant ILD on achievement of clinical remission and the occurrence of undesirable clinical events among patients with RA.

The investigators conducted an observational study utilizing patients from the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort. Patients with chest computed tomography (CT) imaging who failed to achieve baseline remission according to disease activity score 28 (DAS28) data were included.

Time to remission based on DAS28 scores and clinical events occurring within 5 years from baseline were the primary endpoints. Clinical events included death, hospitalization for infection, major adverse cardiac events (MACE), and malignancy.

Determined by CT images, participants were divided into the ILD group (n=287) and the non-ILD group (n=1235).

The investigators found DAS28 remission was reached at least once in 55.7% of the ILD group and in 75.0% of the non-ILD group within 5 years. Failure to reach DAS28 remission was significantly associated with concomitant ILD (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.58-0.89; P =.002).

The investigators noted death (19.5% among the ILD group vs 3.9% among the non-ILD group) was significantly associated with concomitant ILD (aHR, 3.24; 95% CI, 2.08-5.03) as were hospitalization for infection (aHR, 2.60; 95% CI, 1.77-3.83), MACE (aHR, 3.40; 95% CI, 1.76-6.58), and lung cancer occurrence (HR, 16.0; 95% CI, 3.22-79.2; all P <.001).

However, ILD was not associated with malignant lymphoma occurrence (HR, 2.27; 95% CI, 0.59-8.81; P =.23).

Among study limitations, 2782 patients lacking CT images were excluded from the analysis, which may suggest indication bias. Further limitations included errors in self-reporting of unfavorable clinical events and inability to examine the effects of ILD subtypes due to small sample sizes.

“RA patients with concomitant ILD are susceptible to respiratory infections that can be fatal; therefore, these patients should be managed carefully with appropriate screening and monitoring,” study authors noted.

Disclosure: One or more of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.