Rheumatoid arthritis related interstitial lung disease – improving outcomes over 25 years: a large multicentre UK study

Abstract

Objective This study explores whether the prognosis of interstitial lung disease in rheumatoid arthritis (RA-ILD) has improved over time and assesses the potential influence of drug therapy in a large multicentre UK network. Methods We analysed data from 18 UK centres on patients meeting criteria for both RA and ILD diagnosed over a 25-year period. Data included age, disease duration, outcome and cause of death. We compared all cause and respiratory mortality between RA controls and RA-ILD patients, assessing the influence of specific drugs on mortality in four quartiles based on year of diagnosis. Results A total of 290 RA-ILD patients were identified. All cause (respiratory) mortality was increased at 30% (18%) compared with controls 21% (7%) (P =0.02). Overall, prognosis improved over quartiles with median age at death rising from 63 years to 78 years (P =0.01). No effect on mortality was detected as a result of DMARD use in RA-ILD. Relative risk (RR) of death from any cause was increased among patients who had received anti-TNF therapy [2.09 (1.1–4.0)] P =0.03, while RR was lower in those treated with rituximab [0.52(0.1–2.1)] or mycophenolate [0.65 (0.2–2.0)]. Patients receiving rituximab as their first biologic had longer three (92%), five (82%) and seven year (80%) survival than those whose first biologic was an anti-TNF agent (82%, 76% and 64%, respectively) (P =0.037). Discussion This large retrospective multicentre study demonstrates survival of patients with RA-ILD has improved. This may relate to the increasing use of specific immunosuppressive and biologic agents.

Characteristics and Predictors of Progression Interstitial Lung Disease in Rheumatoid Arthritis Compared with Other Autoimmune Disease: A Retrospective Cohort Study

“…These results are similar or even superior to those observed in other cohorts of patients with ILD-SAI [5,[40][41][42]. This improvement is probably associated with increased use of specific immunosuppressants and biologics [43,44]. Furthermore, the predominance of patients with RA (followed by SS and IM) reflects the prevalence reported for each of these diseases elsewhere [45].…”

Rheumatoid arthritis-interstitial lung disease: manifestations and current concepts in pathogenesis and management

“…Cyclophosphamide (CYC) and mycophenolate mofetil (MMF) have been used with varying success, though the suggestion for use are based on limited retrospective and/or uncontrolled studies [94][95][96][97][98][99]. In a retrospective study of 21 patients with progressive RA-ILD (14 with UIP pattern), mean survival time was better in those treated with pulse CYC than in patients with better baseline lung function who did not receive CYC (72 versus 43 months) [95].…”

Rituximab for interstitial pneumonia with autoimmune features at two medical centres

“…Smaller case series in myositis-related ILD ( n = 2–24) and CTD-associated ILD ( n = 24) have suggested effectiveness and safety of RTX [ 26 , 27 ]. Lastly, retrospective studies of patients with ILD associated with RA have shown that RTX treatment is associated with lower risk of functional respiratory impairment and death compared with other therapies [ 28 , 29 ]. The patients in our cohorts had predominantly NSIP or OP patterns on high-resolution CT, whereas RA patients generally have an UIP pattern, which raises the possibility that an autoimmune-associated UIP pattern might respond to RTX in a similar manner [ 28 , 29 ].…”