Predicting outcomes in rheumatoid arthritis related interstitial lung disease

Joseph Jacob, Nikhil Hirani, Coline H.M. Van Moorsel, Srinivasan Rajagopalan, John T. Murchison, Hendrik W. Van Es, Brian Jack Bartholmai, Frouke T. Van Beek, Marjolijn H.L. Struik, Gareth A. Stewart, Maria Kokosi, Ryoko Egashira, Anne Laure Brun, Gary Cross, Joseph Barnett, Anand Devaraj, George Margaritopoulos, Ronald Karwoski, Elisabetta Renzoni, Toby M. MaherAthol U. Wells

Research output: Contribution to journalArticle

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Abstract

The aim of this study was to compare radiology-based prediction models in rheumatoid arthritis-related interstitial lung disease (RAILD) to identify patients with a progressive fibrosis phenotype. RAILD patients had computed tomography (CT) scans scored visually and using CALIPER and forced vital capacity (FVC) measurements. Outcomes were evaluated using three techniques, as follows. 1) Scleroderma system evaluating visual interstitial lung disease extent and FVC values; 2) Fleischner Society idiopathic pulmonary fibrosis (IPF) diagnostic guidelines applied to RAILD; and 3) CALIPER scores of vessel-related structures (VRS). Outcomes were compared to IPF patients. On univariable Cox analysis, all three staging systems strongly predicted outcome (scleroderma system hazard ratio (HR) 3.78, p=9×10−5; Fleischner system HR 1.98, p=2×10−3; and 4.4% VRS threshold HR 3.10, p=4×10−4). When the scleroderma and Fleischner systems were combined, termed the progressive fibrotic system (C-statistic 0.71), they identified a patient subset (n=36) with a progressive fibrotic phenotype and similar 4-year survival to IPF. On multivariable analysis, with adjustment for patient age, sex and smoking status, when analysed alongside the progressive fibrotic system, the VRS threshold of 4.4% independently predicted outcome (model C-statistic 0.77). The combination of two visual CT-based staging systems identified 23% of an RAILD cohort with an IPF-like progressive fibrotic phenotype. The addition of a computer-derived VRS threshold further improved outcome prediction and model fit, beyond that encompassed by RAILD measures of disease severity and extent.

Original languageEnglish (US)
Article number1800869
JournalEuropean Respiratory Journal
Volume53
Issue number1
DOIs
StatePublished - Jan 1 2019

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Interstitial Lung Diseases
Rheumatoid Arthritis
Idiopathic Pulmonary Fibrosis
Vital Capacity
Phenotype
Tomography
Radiology
Fibrosis
Smoking
Guidelines
Survival

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Jacob, J., Hirani, N., Van Moorsel, C. H. M., Rajagopalan, S., Murchison, J. T., Van Es, H. W., ... Wells, A. U. (2019). Predicting outcomes in rheumatoid arthritis related interstitial lung disease. European Respiratory Journal, 53(1), [1800869]. https://doi.org/10.1183/13993003.00869-2018

Predicting outcomes in rheumatoid arthritis related interstitial lung disease. / Jacob, Joseph; Hirani, Nikhil; Van Moorsel, Coline H.M.; Rajagopalan, Srinivasan; Murchison, John T.; Van Es, Hendrik W.; Bartholmai, Brian Jack; Van Beek, Frouke T.; Struik, Marjolijn H.L.; Stewart, Gareth A.; Kokosi, Maria; Egashira, Ryoko; Brun, Anne Laure; Cross, Gary; Barnett, Joseph; Devaraj, Anand; Margaritopoulos, George; Karwoski, Ronald; Renzoni, Elisabetta; Maher, Toby M.; Wells, Athol U.

In: European Respiratory Journal, Vol. 53, No. 1, 1800869, 01.01.2019.

Research output: Contribution to journalArticle

Jacob, J, Hirani, N, Van Moorsel, CHM, Rajagopalan, S, Murchison, JT, Van Es, HW, Bartholmai, BJ, Van Beek, FT, Struik, MHL, Stewart, GA, Kokosi, M, Egashira, R, Brun, AL, Cross, G, Barnett, J, Devaraj, A, Margaritopoulos, G, Karwoski, R, Renzoni, E, Maher, TM & Wells, AU 2019, 'Predicting outcomes in rheumatoid arthritis related interstitial lung disease', European Respiratory Journal, vol. 53, no. 1, 1800869. https://doi.org/10.1183/13993003.00869-2018
Jacob J, Hirani N, Van Moorsel CHM, Rajagopalan S, Murchison JT, Van Es HW et al. Predicting outcomes in rheumatoid arthritis related interstitial lung disease. European Respiratory Journal. 2019 Jan 1;53(1). 1800869. https://doi.org/10.1183/13993003.00869-2018
Jacob, Joseph ; Hirani, Nikhil ; Van Moorsel, Coline H.M. ; Rajagopalan, Srinivasan ; Murchison, John T. ; Van Es, Hendrik W. ; Bartholmai, Brian Jack ; Van Beek, Frouke T. ; Struik, Marjolijn H.L. ; Stewart, Gareth A. ; Kokosi, Maria ; Egashira, Ryoko ; Brun, Anne Laure ; Cross, Gary ; Barnett, Joseph ; Devaraj, Anand ; Margaritopoulos, George ; Karwoski, Ronald ; Renzoni, Elisabetta ; Maher, Toby M. ; Wells, Athol U. / Predicting outcomes in rheumatoid arthritis related interstitial lung disease. In: European Respiratory Journal. 2019 ; Vol. 53, No. 1.
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