Risk factors for rheumatoid arthritis-associated interstitial lung disease: A retrospective study

Aicha Ben Tekaya; Salma Mokaddem; Salma Athimini; Hela Kamoun; Ines Mahmoud; Leila Abdelmoula

doi:10.4081/mrm.2022.877

Risk factors for rheumatoid arthritis-associated interstitial lung disease: A retrospective study

Authors

Aicha Ben Tekaya Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis
Salma Mokaddem Department of Physiology, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis https://orcid.org/0000-0002-7775-3073
Salma Athimini Rheumatology Department, Mahmoud El Matri Hospital, Ariana
Hela Kamoun Pulmonary Department, Abderrahmanen Mami Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tuni
Ines Mahmoud Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis
Leila Abdelmoula Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis

DOI: https://doi.org/10.4081/mrm.2022.877

Keywords:

Rheumatoid arthritis, interstitial lung disease, risk factors

Abstract

Background: The objective of the study was to assess clinical and imaging features of rheumatoid arthritis (RA) associated with interstitial lung disease (ILD), (RA-ILD) group, in comparison to RA without ILD (RA-C) and to identify the associated factors to ILD.
Methods: This was a retrospective comparative study (June 2015 to March 2022) including RA patients aged ≥18 years. The RA-C control group was matched according to age (±2 years), gender, and RA duration (±2 years). General data, RA characteristics, ILD features, and treatment modalities were recorded. Statistical analysis was performed to determine the predictive factors of ILD.
Results: A total of 104 patients were included (52 RA-ILD and 52 RA-C); sex ratio was 0.36. Mean age was 66.3±11 years (RA-ILD) versus 65.6±10.8 years (RA-C) (p=0.72). In comparison to RA-C, RA-ILD patients were significantly higher smokers (p=0.01) and physically inactive (p=0.01). Regarding RA features, RA-ILD patients have significantly increased positive anti-citrullinated peptide antibody (ACPA) (p=0.01), ACPA rate (p<0.001), erosive disease (p<0.001), and disease activity score (p<0.001). Mean time to ILD diagnosis was 5.85±7.16 years. Chest high-resolution computed tomography (HRCT) patterns of disease were identified: nonspecific interstitial pneumonia (NSIP) (28.8%), usual interstitial pneumonia (UIP) (17.3%), organizing pneumonia (OP) (25%), acute interstitial pneumonia (13.5%), and respiratory bronchiolitis (3.8%). Multivariate analysis identified smoking, high baseline DAS28 (disease activity score 28) and ACPA positivity as predictive factors of ILD.
Conclusion: Our results confirmed the reported associated factors of ILD in RA (smoking, higher disease activity, ACPA positivity). Thus, we need to target the modifiable factors by supporting and educating RA patients to quit smoking and intensify disease modifying anti-rheumatoid drugs (DMARD) to reach remission.

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