Kur-Zalewska Joanna, Kisiel Bartłomiej, Kania-Pudło Marta, Tłustochowicz Małgorzata, Chciałowski Andrzej, Tłustochowicz Witold
Department of Internal Diseases and Rheumatology, Military Institute of Medicine, Warsaw, Poland.
Clinical Research Support Center, Military Institute of Medicine, Warsaw, Poland.
PLoS One. 2021 Apr 16;16(4):e0250339. doi: 10.1371/journal.pone.0250339. eCollection 2021.
The aim of the study was to assess the influence of different factors, including treatment, on the risk of ILD in the course of RA.
A total of 109 RA patients were included in the analysis. High-resolution computed tomography (HRCT) of chest was obtained in each patient. Patients were classified as having ILD (ILD group) or not (N-ILD group). The ILD was graded using the semi-quantitative Warrick scale of fibrosis. Warrick extent score (WES) and Warrick severity score (WSS) were calculated separately for each patient, then combined to obtain a global score (WGS).
In univariate analysis the presence of ILD was associated positively with age (P = 5x10-6) and negatively with MTX treatment (P = 0.0013), mean MTX dose per year of treatment (P = 0.003) and number of DMARDs used (P = 0.046). On multivariate analysis only age and treatment with MTX were independently associated with the presence of ILD. WGS was significantly lower in patients treated with MTX in a dose of ≥15 mg/week (MTX≥15 group) as compared to patients treated with lower doses of MTX (0<MTX<15 group) or not treated with MTX (N-MTX group) (P = 0.04 and P = 0.037, respectively). The ILD prevalence was higher in N-MTX group than in 0<MTX<15 group (P = 0.0036) and MTX≥15 group (0.0007). The difference in ILD prevalence between MTX≥15 and 0<MTX<15 groups was not significant, but the latter group had higher WES (P = 0.044) and trended to have higher WSS and WGS.
We found a beneficial effect of MTX on RA-ILD. Importantly, this effect seems to be dose dependent.
本研究旨在评估包括治疗在内的不同因素对类风湿关节炎（RA）病程中发生间质性肺病（ILD）风险的影响。
共109例RA患者纳入分析。对每位患者进行胸部高分辨率计算机断层扫描（HRCT）。患者被分为患有ILD（ILD组）或未患ILD（非ILD组）。使用半定量的沃里克纤维化量表对ILD进行分级。分别计算每位患者的沃里克范围评分（WES）和沃里克严重程度评分（WSS），然后合并得到总体评分（WGS）。
单因素分析中，ILD的存在与年龄呈正相关（P = 5×10⁻⁶），与甲氨蝶呤（MTX）治疗呈负相关（P = 0.0013）、与每年治疗的平均MTX剂量呈负相关（P = 0.003）以及与使用的改善病情抗风湿药（DMARDs）数量呈负相关（P = 0.046）。多因素分析中，只有年龄和MTX治疗与ILD的存在独立相关。与接受较低剂量MTX治疗（0＜MTX＜15组）或未接受MTX治疗（非MTX组）的患者相比，接受≥15 mg/周剂量MTX治疗的患者（MTX≥15组）的WGS显著更低（分别为P = 0.04和P = 0.037）。非MTX组的ILD患病率高于0＜MTX＜15组（P = 0.0036）和MTX≥15组（0.0007）。MTX≥15组和0＜MTX＜15组之间的ILD患病率差异不显著，但后一组的WES更高（P = 0.044），且WSS和WGS有升高趋势。
我们发现MTX对RA-ILD有有益作用。重要的是，这种作用似乎是剂量依赖性的。
