TY - JOUR
T1 - Lifestyle and clinical risk factors for incident rheumatoid arthritis-associated interstitial lung disease
AU - Kronzer, Vanessa L.
AU - Huang, Weixing
AU - Dellaripa, Paul F.
AU - Huang, Sicong
AU - Feathers, Vivi
AU - Lu, Bing
AU - Iannaccone, Christine K.
AU - Gill, Ritu R.
AU - Hatabu, Hiroto
AU - Nishino, Mizuki
AU - Crowson, Cynthia S.
AU - Davis, John M.
AU - Weinblatt, Michael E.
AU - Shadick, Nancy A.
AU - Doyle, Tracy J.
AU - Sparks, Jeffrey A.
N1 - Funding Information:
This work was supported by the Rheumatology Research Foundation K Supplement Award; National Institutes of Health (NIH; grant numbers K23 AR069688, K23 HL119558, R03 AR075886, R03 HL148484, L30 AR066953, P30 AR070253, and P30 AR072577); and the R. Bruce and Joan M. Mickey Research Scholar Fund. The Brigham Rheumatoid Arthritis Sequential Study is funded by grants from Bristol-Myers Squibb, Crescendo Bioscience, and Sanofi. The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the NIH. 1V.L. Kronzer, MD, MSCI, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota;2W. Huang, MSPH, P.F. Dellaripa, MD, S. Huang, MD, MS, V. Feathers, MS, B. Lu, MD, DrPH, M.E. Weinblatt, MD, N.A. Shadick, MD, MPH, J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital and Harvard Medical School, Boston; 3C.K. Iannaccone, MPH, Division of General Internal Medicine, Brigham
Funding Information:
This work was supported by the Rheumatology Research Foundation K Supplement Award; National Institutes of Health (NIH; grant numbers K23 AR069688, K23 HL119558, R03 AR075886, R03 HL148484, L30 AR066953, P30 AR070253, and P30 AR072577); and the R. Bruce and Joan M. Mickey Research Scholar Fund. The Brigham Rheumatoid Arthritis Sequential Study is funded by grants from Bristol-Myers Squibb, Crescendo Bioscience, and Sanofi. The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, its affiliated academic health care centers, or the NIH.
Publisher Copyright:
Copyright © 2021. All rights reserved.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Objective. To determine the association between novel lifestyle factors on risk of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD), define the threshold at which smoking increases RA-ILD risk, and calculate the degree to which known lifestyle and clinical factors predict RA-ILD. Methods. This nested case-control study matched incident RA-ILD cases to RA non-ILD controls on age, sex, RA duration, rheumatoid factor, and time from exposure assessment to RA-ILD. Exposures included education, BMI, smoking, anticyclic citrullinated peptide antibodies, race, joint erosions, rheumatoid nodules, C-reactive protein (CRP), disease activity score, functional status, disease-modifying antirheumatic drug use, and glucocorticoid use. OR for each exposure on risk of RA-ILD were obtained from logistic regression models. Area under the curve (AUC) was calculated based on all lifestyle and clinical exposures. Results. We identified 84 incident RA-ILD cases and 233 matched controls. After adjustment, obesity, high-positive CRP (≥ 10 mg/L), and poor functional status (multidimensional Health Assessment Questionnaire [MDHAQ] ≥ 1) were associated with increased risk of RA-ILD (OR 2.42, 95% CI 1.11-5.24 vs normal BMI; OR 2.61, 95% CI 1.21-5.64 vs CRP < 3 mg/L; OR 3.10, 95% CI 1.32-7.26 vs MDHAQ < 0.2). Smoking 30 pack-years or more was strongly associated with risk of RA-ILD compared to never smokers (OR 6.06, 95% CI 2.72-13.5). Together, lifestyle and clinical risk factors for RA-ILD had an AUC of 0.79 (95% CI 0.73-0.85). Conclusion. Obesity, CRP, functional status, and extensive smoking may be novel risk factors for RA-ILD that may be useful for RA-ILD risk assessment and prevention. The overall ability to predict RA-ILD remains modest.
AB - Objective. To determine the association between novel lifestyle factors on risk of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD), define the threshold at which smoking increases RA-ILD risk, and calculate the degree to which known lifestyle and clinical factors predict RA-ILD. Methods. This nested case-control study matched incident RA-ILD cases to RA non-ILD controls on age, sex, RA duration, rheumatoid factor, and time from exposure assessment to RA-ILD. Exposures included education, BMI, smoking, anticyclic citrullinated peptide antibodies, race, joint erosions, rheumatoid nodules, C-reactive protein (CRP), disease activity score, functional status, disease-modifying antirheumatic drug use, and glucocorticoid use. OR for each exposure on risk of RA-ILD were obtained from logistic regression models. Area under the curve (AUC) was calculated based on all lifestyle and clinical exposures. Results. We identified 84 incident RA-ILD cases and 233 matched controls. After adjustment, obesity, high-positive CRP (≥ 10 mg/L), and poor functional status (multidimensional Health Assessment Questionnaire [MDHAQ] ≥ 1) were associated with increased risk of RA-ILD (OR 2.42, 95% CI 1.11-5.24 vs normal BMI; OR 2.61, 95% CI 1.21-5.64 vs CRP < 3 mg/L; OR 3.10, 95% CI 1.32-7.26 vs MDHAQ < 0.2). Smoking 30 pack-years or more was strongly associated with risk of RA-ILD compared to never smokers (OR 6.06, 95% CI 2.72-13.5). Together, lifestyle and clinical risk factors for RA-ILD had an AUC of 0.79 (95% CI 0.73-0.85). Conclusion. Obesity, CRP, functional status, and extensive smoking may be novel risk factors for RA-ILD that may be useful for RA-ILD risk assessment and prevention. The overall ability to predict RA-ILD remains modest.
KW - Interstitial lung disease
KW - Obesity
KW - Respiratory diseases
KW - Rheumatoid arthritis
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U2 - 10.3899/jrheum.200863
DO - 10.3899/jrheum.200863
M3 - Article
C2 - 33191286
AN - SCOPUS:85105681712
SN - 0315-162X
VL - 48
SP - 656
EP - 663
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 5
ER -