Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease that confers a poor prognosis. Previously, immunoglobulin A (IgA) level has been used as a surrogate marker of transforming growth factor (TGF)-beta, an important mediator of pulmonary fibrosis, and increased IgA level was associated with worse outcomes in IPF [1]. Recent studies have also described associations between serum monocyte count and clinical outcomes in IPF [2]. Rheumatoid arthritis related interstitial lung disease (RA-ILD) has many similarities with IPF, including similar genetic risk, survival, and ILD pattern. We hypothesized that elevated IgA and monocyte count would correlate with clinical outcomes and ILD patterns in RA-ILD.
METHODS:We performed a single-center, retrospective chart review of patients diagnosed with RA-ILD between 2010 and 2021 using an ICD9 and ICD10 based search. Of 256 patients who met our search criteria, 77 were included in the final analysis. Patients were included if they had serum IgA and monocyte count in the chart, a confirmed diagnosis of RA based on ACR/ EULAR criteria, and ILD based on chart diagnosis and confirmatory imaging. Patients were excluded if they received rituximab prior to their blood draw. High resolution computed tomography images closest to the date of the blood draw were analyzed by consensus reads by two blinded thoracic radiologists using the 2018 ATS/ERS/JRS/ALAT guidelines. IgA level and monocyte count were compared to pulmonary function at time of blood draw, time to death or lung transplant, UIP pattern as well as sex, ethnicity and age.
RESULTS:The mean and median IgA levels were 342.8 mg/dl and 329.0 mg/dl, respectively. There was no statistically significant association between IgA level and the UIP pattern (p = 0.689). IgA level was not associated with baseline FVC% predicted or baseline DLCO% predicted (p = 0.218 and p = 0.639). The effect of IgA level on overall survival is not significant in the simple Cox regression model [hazard ratio (HR) = 1.002, 95% confidence interval (CI) 0.999-1.004, p = 0.203].The mean and median absolute monocyte counts were 6.5Â108 cells/liter and 6.0Â108 cells/liter, respectively. There was no association between monocyte count and the UIP pattern (p = 0.762). Monocyte count was not associated baseline with FVC% predicted (p = 0.963) or baseline DLCO% predicted (p = 0.882). The effect of monocyte count on overall survival is not significant in the simple Cox regression model (HR = 1.099, 95% CI 0.449-2.690, p = 0.836).CONCLUSIONS: Serum IgA and monocyte concentration were not associated with important clinical outcomes in this RA-ILD cohort. This was a retrospective analysis, it may be that prospective, longitudinal analysis of IgA and monocyte count in RA-ILD could yield different results.
Mrs. T., admitted May 10th, 1852. Age 34; married. An intelligent woman of kindly and somewhat melancholy disposition, active habits, and nervo-bilious temperament. First attack; duration 14 days; assigned cause, religious excitement; was nursing her fifth child. Fancied that her husband and other relations were going to murder her, and were plotting against her, and expressed many delusions of a religious character. Had attempted suicide by precipitation. There was hereditary predisposition to insanity. Her general health was good.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.