Progressive Decline of Lung Function in Rheumatoid Arthritis–Associated Interstitial Lung Disease

Jorge A. Zamora-Legoff, Megan L. Krause, Cynthia Crowson, Jay H Ryu, Eric Lawrence Matteson

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: Interstitial lung disease (ILD) is associated with substantial morbidity in rheumatoid arthritis (RA), but very little is known about its long-term progression. This study was undertaken to investigate the progression of pulmonary disease using a large single-center cohort of patients with RA-associated ILD. Methods: Records of all patients with RA-associated ILD seen at Mayo Clinic between 1998 and 2014, with at least 4 weeks follow-up and at least 1 pulmonary function test, were identified and manually screened for study inclusion. Progression was defined as a diffusing capacity for carbon monoxide (DLco) <40% predicted (or patients whose illness was too advanced to undergo screening) or a forced vital capacity (FVC) <50% predicted. Time to progression was analyzed using the Kaplan-Meier method. Results: Of the 167 patients included in the study, 81 (49%) were female, with a mean ± SD age of 67 ± 10 years at diagnosis of ILD. Median follow-up time from diagnosis of ILD was 3.3 years (range 0.01–14.8). One-third of the patients required supplemental oxygen, 40% developed DLco <40% predicted, and 22% developed FVC <50% predicted within 5 years after ILD diagnosis. Usual interstitial pneumonia (UIP) versus nonspecific interstitial pneumonia (NSIP) was a risk factor for DLco progression (hazard ratio 3.29 [95% confidence interval 1.28–8.41]). Lower DLco and FVC at baseline increased the risk for progression to DLco <40% predicted and FVC <50% predicted, and higher rates of change in the first 6 months also increased the risk of progression. Conclusion: Progressive loss of pulmonary function is common in RA-associated ILD and is worse in patients with UIP than in those with NSIP. Predictors of progression in patients with RA-associated ILD may aid clinicians in identifying patients at highest risk for progression of ILD.

Original languageEnglish (US)
Pages (from-to)542-549
Number of pages8
JournalArthritis and Rheumatology
Volume69
Issue number3
DOIs
StatePublished - Mar 1 2017

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Interstitial Lung Diseases
Lung
Vital Capacity
Rheumatoid Arthritis
Idiopathic Pulmonary Fibrosis
Respiratory Function Tests
Carbon Monoxide
Lung Diseases
Confidence Intervals
Oxygen
Morbidity

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology

Cite this

Progressive Decline of Lung Function in Rheumatoid Arthritis–Associated Interstitial Lung Disease. / Zamora-Legoff, Jorge A.; Krause, Megan L.; Crowson, Cynthia; Ryu, Jay H; Matteson, Eric Lawrence.

In: Arthritis and Rheumatology, Vol. 69, No. 3, 01.03.2017, p. 542-549.

Research output: Contribution to journalArticle

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title = "Progressive Decline of Lung Function in Rheumatoid Arthritis–Associated Interstitial Lung Disease",
abstract = "Objective: Interstitial lung disease (ILD) is associated with substantial morbidity in rheumatoid arthritis (RA), but very little is known about its long-term progression. This study was undertaken to investigate the progression of pulmonary disease using a large single-center cohort of patients with RA-associated ILD. Methods: Records of all patients with RA-associated ILD seen at Mayo Clinic between 1998 and 2014, with at least 4 weeks follow-up and at least 1 pulmonary function test, were identified and manually screened for study inclusion. Progression was defined as a diffusing capacity for carbon monoxide (DLco) <40{\%} predicted (or patients whose illness was too advanced to undergo screening) or a forced vital capacity (FVC) <50{\%} predicted. Time to progression was analyzed using the Kaplan-Meier method. Results: Of the 167 patients included in the study, 81 (49{\%}) were female, with a mean ± SD age of 67 ± 10 years at diagnosis of ILD. Median follow-up time from diagnosis of ILD was 3.3 years (range 0.01–14.8). One-third of the patients required supplemental oxygen, 40{\%} developed DLco <40{\%} predicted, and 22{\%} developed FVC <50{\%} predicted within 5 years after ILD diagnosis. Usual interstitial pneumonia (UIP) versus nonspecific interstitial pneumonia (NSIP) was a risk factor for DLco progression (hazard ratio 3.29 [95{\%} confidence interval 1.28–8.41]). Lower DLco and FVC at baseline increased the risk for progression to DLco <40{\%} predicted and FVC <50{\%} predicted, and higher rates of change in the first 6 months also increased the risk of progression. Conclusion: Progressive loss of pulmonary function is common in RA-associated ILD and is worse in patients with UIP than in those with NSIP. Predictors of progression in patients with RA-associated ILD may aid clinicians in identifying patients at highest risk for progression of ILD.",
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