Lifestyle and clinical risk factors for incident rheumatoid arthritis-associated interstitial lung disease

Vanessa L. Kronzer, Weixing Huang, Paul F. Dellaripa, Sicong Huang, Vivi Feathers, Bing Lu, Christine K. Iannaccone, Ritu R. Gill, Hiroto Hatabu, Mizuki Nishino, Cynthia S. Crowson, John M. Davis, Michael E. Weinblatt, Nancy A. Shadick, Tracy J. Doyle, Jeffrey A. Sparks

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)656-663
Number of pages8
JournalJournal of Rheumatology
Issue number5
StatePublished - May 1 2021


  • Interstitial lung disease
  • Obesity
  • Respiratory diseases
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology


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