Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain.
Pneumology Department, Hospital Clínico San Carlos, Madrid, Spain.
Rheumatology (Oxford). 2020 Aug 1;59(8):2099-2108. doi: 10.1093/rheumatology/kez673.
To asses the clinical course in RA-related interstitial lung disease (RA-ILD) patients with and without rituximab (RTX). The influence of other variables was also evaluated.
A longitudinal multicentre study was conducted in RA diagnosed with ILD from 2007 until 2018 in Madrid. Patients were included in a registry [pNEumology RhEumatology Autoinmune diseases (NEREA)] from the time of ILD diagnosis. The main endpoint was functional respiratory impairment (FI), when there was a decline ≥5% in the predicted forced vital capacity compared with the previous one. Pulmonary function was measured at baseline and in follow-up visits every 6-12 months. The independent variable was therapy with RTX. Covariables included sociodemographic, clinical, radiological and other therapies. Survival techniques were used to estimate the incidence rate (IR) and 95% CI of functional impairment, expressed per 100 patient-semesters. Cox multivariate regression models were run to examine the influence of RTX and other covariates on FI. Results were expressed as the hazard ratio (HR) and CI.
A total of 68 patients were included. FI occurred in 42 patients [IR 23.5 (95% CI 19, 29.1)] and 50% of them had FI within 1.75 years of an ILD diagnosis. A multivariate analysis showed that RTX exposure resulted in a lower risk of FI compared with non-exposure [HR 0.51 (95% CI 0.31, 0.85)]. Interstitial pneumonia, glucocorticoids, disease activity and duration also influenced FI.
RA-ILD patients deteriorate over time, with the median time free of impairment being <2 years. Patients exposed to RTX had a higher probability of remaining free of FI compared with other therapies. Other factors have also been identified.
评估类风湿关节炎相关间质性肺疾病（RA-ILD）患者在使用利妥昔单抗（RTX）和不使用 RTX 情况下的临床病程。还评估了其他变量的影响。
这是一项在马德里进行的 2007 年至 2018 年间诊断为 ILD 的类风湿关节炎患者的纵向多中心研究。患者从ILD 诊断时开始被纳入一个登记处[pNEumology RhEumatology Autoinmune diseases (NEREA)]。主要终点是功能性呼吸损害（FI），即与前一次相比，预计用力肺活量下降≥5%。在基线和之后每 6-12 个月的随访中测量肺功能。自变量是 RTX 治疗。协变量包括社会人口统计学、临床、影像学和其他治疗。使用生存技术来估计功能损害的发生率（IR）和 95%CI，每 100 个患者-半学年表示。进行 Cox 多变量回归模型来检查 RTX 和其他协变量对 FI 的影响。结果表示为危险比（HR）和 CI。
共纳入 68 例患者。42 例患者发生 FI（IR 23.5（95%CI 19，29.1）），其中 50%的患者在 ILD 诊断后 1.75 年内发生 FI。多变量分析显示，与未暴露相比，RTX 暴露降低了 FI 的风险[HR 0.51（95%CI 0.31，0.85）]。间质性肺炎、糖皮质激素、疾病活动度和病程也影响 FI。
RA-ILD 患者随时间恶化，无损害中位时间<2 年。与其他治疗相比，暴露于 RTX 的患者保持 FI 无恶化的可能性更高。还确定了其他因素。
