Acute Respiratory Deterioration in Rheumatoid Arthritis-Associated Interstitial Lung Disease

医学 内科学 间质性肺病 类风湿性关节炎 恶化 累积发病率 危险系数 入射(几何) 类风湿因子 肺功能测试 胃肠病学 外科 队列 置信区间 物理 光学
作者
Byoung Soo Kwon,Ho‐Young Lee,Jooae Choe,Eun Jin Chae,Sungeun Hong,Jin Woo Song
出处
期刊:Chest [Elsevier]
卷期号:162 (1): 136-144 被引量:6
标识
DOI:10.1016/j.chest.2022.01.007
摘要

Interstitial lung disease (ILD) is associated with increased morbidity and mortality in rheumatoid arthritis (RA). Moreover, acute exacerbation (AE) is a devastating complication of RA plus ILD. However, few data on AE in RA-associated ILD are available.What are the incidence, risk factors, and outcomes of AE in patients with RA-associated ILD?The clinical data of 310 patients with RA-associated ILD were analyzed retrospectively. AE was defined as the acute worsening of dyspnea typically within 30 days with new bilateral lung infiltration, which was based on a 2016 report by an international working group.The mean age of the participants was 61.9 years, and 56.2% of them were women. During follow-up (median, 47.7 months), AE occurred in 87 patients (28.1%). The 1-year, 3-year, and 5-year cumulative incidence rates of AE in patients with RA-associated ILD were 9.2%, 19.8%, and 29.4%, respectively. Ever smoker status, lower FVC, and shorter 6-min walk distance were significant risk factors for the occurrence of AE. In the multivariate Cox analysis adjusted by age, sex, smoking status, lung function, exercise capacity, and high-resolution CT scan pattern, AE was a significant prognostic factor for overall survival (hazard ratio, 2.423; 95% CI, 1.605-3.660; P < .001) in patients with RA-associated ILD. The 30-day and 90-day mortalities after AE were 12.6% and 29.9%, respectively.Our findings suggest that approximately one-third of patients with RA-associated ILD experience AE and that ever smoker status, and lower lung function and exercise capacity predispose patients to AE. AE significantly affects the overall survival of patients with RA-associated ILD.
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