Ab0195 factors Related to Radiographic Progression in Patients With Rheumatoid Arthritis-Related Interstitial Lung Disease

Abstract

Background:Interstitial lung disease is an important cause of mortality and morbidity for RA. Lung computerized tomography (CT) is a valid method for the detection of interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients. Besides, CT may have a role in the detection of progression in RA-ILD.Objectives:To compare the clinical and radiological features of RA-ILD patients with and without radiographic progression according to lung CT.Methods:From the hospital database, all patients recorded as having RA according to ICD-10 code and had a lung CT examination were recruited. RA was confirmed in 822 of 2305 (35.6%) records. Three radiologists re-evaluated lung CTs and 156/822 (18.9%) patients with had RA-ILD. Of these 156 patients, 101 (64.7%) had at least 1 follow-up long CT and these patients were included to analysis. Demographic and clinical data of the patients were recorded. ILD was divided into 3 main groups by radiologists: Usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP) and airway disease (AD) (bronchiectasis and/or bronchiolitis without parenchymal involvement). Avila et al reported a grading system to assess the severity of ILD using HRCT (1). In our study we utilized a similar method using interlobular septal thickening, ground glass opacities, reticulations, traction bronchiectasis and honeycomb appearance as elementary findings to evaluate the RA associated ILD. Septal thickening, reticulations and ground glass opacities were considered as relatively mild features whereas traction bronchiectasis and honey comb appearance were considered as severe findings as those frequently result from advanced fibrosis. The lungs were divided into upper, middle and lower zones each with equal number of slices. Progression was defined as involvement of more zones in vertical extent by the same elementary findings or emergence of more severe findings (i.e traction bronchiectasis or honey comb appearance) in the same zones compared to previous exam. For the multivariate analysis, the possible factors identified with univariate analyses were further entered into the logistic regression analysis to determine independent predictors of radiographic progression.Results:In this study, 101 patients with 215 lung CT were included to analysis. 67 (66.3%) patients had 3 CTs, 30 (29.9%) patients 4 CTs and 17 (16.9%) patients had 5 CTs. Mean duration between first and last CT was 47.7±38.8 months. Of 101 patients, radiographic progression was seen in 42 (41.6%) patients. Univariate comparison of demographic, clinical and radiographic features of patients with or without radiographic progression were given in Table. In multivariate analysis (adjusted for ILD disease duration)having ground-glass opacity(aOR 8.6; CI: 1.65-44.9; p=0.011),male gender(aOR 2.9; CI: 1.13-7.4; p=0.026) were found as independent risk factors radiographic progression, whiletaking methotrexate (ever) (aOR 0.21; CI: 0.07-0.6; p=0.04) was found as an independent protector factor for radiographic progression.Conclusion:The prediction of ILD progression in RA patients were a challenge for clinicians. According to lung CT, baseline ground-glass opacities looks like prominent factor for ILD progression, particularly at male RA patients. Using methotrexate in ILD patients is a dilemma in routine practice, our results demonstrate that methotrexate (not other cs or bDMARDs) is protective drugs for ILD progression, however these results should be confirmed in the further studies.References:[1]Avila NA. AJR Am J Roentgenol. 2002;179(4): 887-892Disclosure of Interests:Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Mustafa Ekici: None declared, Emre Bilgin: None declared, Alper Sari: None declared, Yusuf Baytar: None declared, Ertugrul Cagri Bolek: None declared, Berkan Armagan: None declared, Bayram Farisoğullari: None declared, Omer Karadag: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Levent Kiliç: None declared, Şule Apraş Bilgen: None declared, Gamze Durhan: None declared, Ali Akdoğan: None declared, Macit Ariyürek: None declared