Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education Key Laboratory, Beijing, China.
Clin Rev Allergy Immunol. 2021 Feb;60(1):46-54. doi: 10.1007/s12016-020-08819-0. Epub 2020 Nov 10.
The aim of this study is to investigate the clinical features and outcome of interstitial lung disease (ILD)-onset rheumatoid arthritis (RA) and anti-citrullinated protein antibody (ACPA)-positive ILD-only patients. Arthritis-onset and ILD-onset RA-ILD and ACPA-positive ILD-only patients consecutively admitted to Peking Union Medical College Hospital from January 2008 to December 2017 were enrolled and followed-up. Their demographic, clinical, and laboratory features as well as outcome were collected and analyzed. Compared with arthritis-onset RA-ILD (n = 166, median arthritis-to-ILD interval: 60 months), the ILD-onset RA-ILD (n = 75, median ILD-to-arthritis interval: 2 months) had less rheumatoid nodules and higher titer of ACPA, and manifested more stable ILD (median estimated progression-free survival: 120 vs. 100 months, p = 0.019). Elder age (≥ 65 years) at ILD diagnosis and UIP pattern were associated with ILD progression by both univariate and Cox hazards modeling analysis (p < 0.05). In ACPA-positive ILD-only patients (n = 41), arthritis developed in 7 (17.1%) female patients after a median interval of 24 months. ACPA-positive ILD who subsequently developed arthritis exhibited higher frequency of rheumatoid factor (RF), higher titer of ACPA, and higher levels of ESR and CRP (p < 0.05). Multivariate regression analysis showed that positive RF (OR 12.55, 95% CI 1.31 to 120.48) was the independent risk factor for arthritis development in ACPA-positive ILD-only patients. ILD-onset RA-ILD had more stable ILD compared with arthritis-onset RA-ILD. ACPA-positive ILD patients with positive RF are at increased risk of developing RA.
本研究旨在探讨间质性肺病（ILD）起病的类风湿关节炎（RA）和抗瓜氨酸化蛋白抗体（ACPA）阳性ILD 患者的临床特征和结局。连续纳入 2008 年 1 月至 2017 年 12 月期间北京协和医院收治的关节炎起病和 ILD 起病的 RA-ILD 及 ACPA 阳性 ILD 患者，并进行随访。收集并分析其人口统计学、临床和实验室特征以及结局。与关节炎起病的 RA-ILD（n=166，关节炎至 ILD 的中位间隔：60 个月）相比，ILD 起病的 RA-ILD（n=75，ILD 至关节炎的中位间隔：2 个月）患者的类风湿结节较少，ACPA 滴度较高，ILD 更稳定（中位估计无进展生存期：120 个月比 100 个月，p=0.019）。ILD 诊断时年龄≥65 岁和 UIP 模式与单因素和 Cox 风险模型分析均与 ILD 进展相关（p<0.05）。在 ACPA 阳性 ILD 患者（n=41）中，中位间隔 24 个月后有 7（17.1%）名女性患者出现关节炎。随后发生关节炎的 ACPA 阳性 ILD 患者 RF 阳性频率更高、ACPA 滴度更高、ESR 和 CRP 水平更高（p<0.05）。多变量回归分析显示，RF 阳性（OR 12.55，95%CI 1.31 至 120.48）是 ACPA 阳性 ILD 患者发生关节炎的独立危险因素。与关节炎起病的 RA-ILD 相比，ILD 起病的 RA-ILD 患者的 ILD 更稳定。RF 阳性的 ACPA 阳性 ILD 患者发生 RA 的风险增加。
