Predictors of mortality in rheumatoid arthritis-associated lung disease: A retrospective study on ten years

Ekici, Mustafa Ayhan; Baytar, Yusuf; Kardaş, Rıza Can; Sarı, Alper; Akdoğan, Ali; Durhan, Gamze; Arıyürek, M.; Kalyoncu, Umut

doi:10.1016/j.jbspin.2021.105133

Cited by 13 publications

(13 citation statements)

References 14 publications

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“…Furthermore, an algorithm (Vector) to detect the presence of velcro crackles in pulmonary sounds showed promising results for screening RA patients suspected of ILD and who should be directed to HRCT for the diagnosis ( 12 ). But, only a few tools seem to have the potential for driving treatment strategy ( 13 – 15 ), mostly involving the shifts in levels of selected serum proteins, such as CXCL11/I-TAC and matrix metalloproteinase-13, which may not be available in routine clinical practice. Radiomics has been helpful in phenotyping cancers ( 8 , 16 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

Radiomics to predict the mortality of patients with rheumatoid arthritis-associated interstitial lung disease: A proof-of-concept study

et al. 2023

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ObjectivesPatients with rheumatoid arthritis (RA) and interstitial lung disease (ILD) have increased mortality compared to the general population and factors capable of predicting RA-ILD long-term clinical outcomes are lacking. In oncology, radiomics allows the quantification of tumour phenotype by analysing the characteristics of medical images. Using specific software, it is possible to segment organs on high-resolution computed tomography (HRCT) images and extract many features that may uncover disease characteristics that are not detected by the naked eye. We aimed to investigate whether features from whole lung radiomic analysis of HRCT may alone predict mortality in RA-ILD patients.MethodsHigh-resolution computed tomographies of RA patients from January 2012 to March 2022 were analyzed. The time between the first available HRCT and the last follow-up visit or ILD-related death was recorded. We performed a volumetric analysis in 3D Slicer, automatically segmenting the whole lungs and trachea via the Lung CT Analyzer. A LASSO-Cox model was carried out by considering ILD-related death as the outcome variable and extracting radiomic features as exposure variables.ResultsWe retrieved the HRCTs of 30 RA-ILD patients. The median survival time (interquartile range) was 48 months (36–120 months). Thirteen out of 30 (43.33%) patients died during the observation period. Whole line segmentation was fast and reliable. The model included either the median grey level intensity within the whole lung segmentation [high-resolution (HR) 9.35, 95% CI 1.56–55.86] as a positive predictor of death and the 10th percentile of the number of included voxels (HR 0.20, 95% CI 0.05–0.84), the voxel-based pre-processing information (HR 0.23, 95% CI 0.06–0.82) and the flatness (HR 0.42, 95% CI 0.18–0.98), negatively correlating to mortality. The correlation of grey level values to their respective voxels (HR 1.52 95% CI 0.82–2.83) was also retained as a confounder.ConclusionRadiomic analysis may predict RA-ILD patients’ mortality and may promote HRCT as a digital biomarker regardless of the clinical characteristics of the disease.

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Section: Discussionmentioning

confidence: 99%

Radiomics to predict the mortality of patients with rheumatoid arthritis-associated interstitial lung disease: A proof-of-concept study

et al. 2023

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“…In the Izuka's retrospective study, RA-ILD in a UIP pattern was associated with the acute exacerbations and death [57] . Furthermore, patients with RA-ILD in a UIP pattern had a similar clinical phenotype and prognosis to patients with IPF [30,61–63] . Although the survival of RA-ILD has improved since the use of DMARDs, ILD remains a potentially life-threatening complication of RA [64,65] .…”

Section: Ra-associated Ildmentioning

confidence: 99%

Diffuse lung involvement in rheumatoid arthritis: a respiratory physician's perspective

Huang

Chen

Shao

et al. 2023

Chinese Medical Journal

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The lungs are one of the most common extra-articular organs involved in rheumatoid arthritis (RA), which is reported to occur in up to 60% to 80% of RA patients. Respiratory complications are the second leading cause of death due to RA. Although there is a wide spectrum of RA-associated respiratory diseases, interstitial lung disease is the most common manifestation and it impacts the prognosis of RA. There has been progress in understanding the management and progression of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and RA-associated respiratory diseases recently, for example, opportunistic pulmonary infectious diseases and toxicity from RA therapies. From a chest physicians' perspective, we will update the diagnosis and treatment of RA-associated ILD, methotrexate-associated lung disease, and the complication of Pneumocystis jiroveci pneumonia in RA in this review.

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“…While time-dependent decline in lung function correlates with mortality in RA-ILD ( 13 , 33 ), other prognostic factors include older age, male sex, smoking habit, or the presence of comorbidities ( 13 , 34 ) such as RA disease activity and the use of systemic glucocorticoids ( 13 , 34 ). Additional poor prognostic features include pleural effusion, short time between RA diagnosis and ILD occurrence ( 35 ), as well as the radiologic pattern at HRCT with UIP pattern predicting mortality ( 13 , 33 , 36 ) and correlating with an increased risk of acute exacerbations and lung cancer ( 36 ).…”

Section: Introductionmentioning

confidence: 99%

Unmet needs and perspectives in rheumatoid arthritis-associated interstitial lung disease: A critical review

et al. 2023

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Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by synovitis as the most common clinical manifestation, and interstitial lung disease (RA-ILD) represents one of the most common and potentially severe extra-articular features. Our current understanding of the mechanisms and predictors of RA-ILD is limited despite the demonstration that an early identification of progressive fibrosing forms is crucial to provide timely treatment with antifibrotic therapies. While high resolution computed tomography is the gold standard technique for the diagnosis and follow-up of RA-ILD, it has been hypothesized that serum biomarkers (including novel and rare autoantibodies), new imaging techniques such as ultrasound of the lung, or the application of innovative radiologic algorithms may help towards predicting and detecting early forms of diseases. Further, while new treatments are becoming available for idiopathic and connective tissue disease-associated forms of lung fibrosis, the treatment of RA-ILD remains anecdotal and largely unexplored. We are convinced that a better understanding of the mechanisms connecting RA with ILD in a subgroup of patients as well as the creation of adequate diagnostic pathways will be mandatory steps for a more effective management of this clinically challenging entity.

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Predictors of mortality in rheumatoid arthritis-associated lung disease: A retrospective study on ten years

Cited by 13 publications

References 14 publications

Radiomics to predict the mortality of patients with rheumatoid arthritis-associated interstitial lung disease: A proof-of-concept study

Radiomics to predict the mortality of patients with rheumatoid arthritis-associated interstitial lung disease: A proof-of-concept study

Diffuse lung involvement in rheumatoid arthritis: a respiratory physician's perspective

Unmet needs and perspectives in rheumatoid arthritis-associated interstitial lung disease: A critical review

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