Chronic lung disease in U.S. Veterans with rheumatoid arthritis and the impact on survival

Abstract

Introduction/Objectives: Assess the impact of chronic lung diseases (CLD) on survival in rheumatoid arthritis (RA). Method: Among participants in the Veterans Affairs Rheumatoid Arthritis (VARA) Registry, a prospective cohort of U.S. Veterans with RA, we identified CLD and cardiovascular disease (CVD) using administrative and registry data. Demographics, smoking status, RA characteristics including Disease Activity Score in 28 joints (DAS28), and disease-modifying anti-rheumatic drug (DMARD) use were obtained from registry data, which was linked to the National Death Index to obtain vital status. We evaluated associations of CLD with survival using multivariable Cox regression models. Results: Among a large (n=2,053), male predominant (91%) RA cohort, 554 (27%) had CLD at enrollment. Mortality risk was increased 1.51-fold (95% CI 1.26–1.81) in RA patients with CLD after multivariable adjustment, a risk that was similar to that observed with CVD (HR CLD alone 1.46 [1.03–2.06]; CVD alone 1.62 [1.35–1.94]). Survival was significantly reduced in those with interstitial lung disease (ILD) as well as other forms of CLD. Mortality risk with methotrexate and biologic use was not different in those with CLD compared to those without (p interaction ≥ 0.15) using multiple exposure definitions and propensity score adjustment. Conclusions: Mortality risk is significantly increased in RA patients with CLD. This risk is attributable not only to ILD but also to other chronic lung conditions and does not appear to be substantially greater in those receiving methotrexate or biologic therapies. Comorbid lung disease should be targeted as a means of improving long-term outcomes in RA.

Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts

“…Such delays are likely to worsen RA outcomes by unnecessarily denying patients the anchor csDMARD for this disease. Reassurance of the benign effect of MTX on established RA-ILD comes from no association found between MTX and hospitalised severe ILD episodes in USA National Databank for Rheumatic Diseases27 and mortality from ILD in the USA Veterans Affairs Rheumatoid Arthritis Registry 28. Furthermore, a retrospective analysis of prognostic factors in 78 cases of RA-ILD, where MTX was specifically used as a therapeutic agent in 67%, found this to be strongly associated with survival 29…”

Decreased comorbidities in rheumatoid arthritis patients treated with a biologic agent

“…Likewise, respiratory failure is mostly caused by inflammation [30] and increased oxidative stress [31]. Biologics may be significantly associated with lung disease in RA patients [32][33][34]. Another review article mentioned that MTX, LEF, TNFi, RTX, and TCZ may cause pneumonitis [35], which was not demonstrated in our current study and warrants further investigation.…”

Incidence and Predictors of Dyspnea on Exertion in a Prospective Cohort of Patients With Rheumatoid Arthritis

“…Our study highlights RA as a vulnerable population related to this important patient-reported outcome(7). A recent study of mostly men in the Veteran Affairs RA registry showed that chronic lung disease was associated with increased mortality(16) further underscoring the importance of understanding the effect of respiratory factors on health for patients with RA. In the analysis comparing subjects with prevalent clinically significant dyspnea on exertion to those without, subjects with clinically significant dyspnea on exertion had high rates of smoking, sedentary activity, poor functional status, excess comorbidities, and more severe RA.…”