Van Kalsbeek Daniel, Brooks Rebecca, Shaver Dawson, Ebel Ariadne, Hershberger Daniel, Schmidt Cynthia, Poole Jill A, Ascherman Dana P, Thiele Geoffrey M, Mikuls Ted R, England Bryant R
University of Nebraska Medical Center, Omaha.
University Health Care System, Augusta, Georgia.
ACR Open Rheumatol. 2023 Apr;5(4):201-226. doi: 10.1002/acr2.11535. Epub 2023 Feb 28.
BACKGROUND: Biomarkers have been proposed as tools to aid in the identification and prognostication of interstitial lung disease (ILD) in rheumatoid arthritis (RA). We performed a systematic review of studies evaluating peripheral blood biomarkers and their association with RA-ILD and its prognosis. METHODS: Medline, Embase, the Cochrane Library, and Scopus were queried for relevant studies, with the final search update on July 12, 2021. We included studies evaluating peripheral blood biomarkers for the identification and/or prognostication of RA-ILD, extracting the performance of individual biomarkers for identifying RA-ILD, and predicting prognosis. Modified versions of the Quality Assessment of Diagnostic Accuracy Studies 2 and the Quality in Prognosis Studies tools were used for quality assessment. RESULTS: Seventy studies met eligibility criteria. Study and patient characteristics, analytical methods, strength and consistency of associations, and study quality were heterogeneous. A total of 92 biomarkers were positively associated and 12 were negatively associated with RA-ILD among patients with RA in one or more report. Only a small number of biomarkers were evaluated in multiple cohorts using adjusted analyses. Biomarkers most strongly associated with RA-ILD overlapped with those identified for idiopathic pulmonary fibrosis. Few prognostic biomarkers of RA-ILD were identified. CONCLUSION: Several peripheral blood biomarkers are associated with the presence of RA-ILD, but few have been assessed in multivariable models, have been externally validated, have discriminated RA-ILD from other lung disease, or have prognosticated the disease course. High-quality studies investigating and validating peripheral biomarkers in RA-ILD are needed before they can be employed in clinical care.
背景:生物标志物已被提议作为辅助识别和预测类风湿关节炎(RA)相关间质性肺疾病(ILD)的工具。我们对评估外周血生物标志物及其与RA-ILD的关联及其预后的研究进行了系统综述。 方法:检索了Medline、Embase、Cochrane图书馆和Scopus以查找相关研究,最后一次检索更新于2021年7月12日。我们纳入了评估外周血生物标志物用于识别和/或预测RA-ILD的研究,提取了个体生物标志物识别RA-ILD和预测预后的性能。使用诊断准确性研究质量评估2的修改版和预后研究质量工具进行质量评估。 结果:70项研究符合纳入标准。研究和患者特征、分析方法、关联的强度和一致性以及研究质量存在异质性。在一份或多份报告中,共有92种生物标志物与RA患者中的RA-ILD呈正相关,12种呈负相关。只有少数生物标志物在多个队列中使用校正分析进行了评估。与RA-ILD关联最密切的生物标志物与特发性肺纤维化中确定的生物标志物重叠。RA-ILD的预后生物标志物很少被确定。 结论:几种外周血生物标志物与RA-ILD的存在有关,但很少有在多变量模型中进行评估、经过外部验证、能将RA-ILD与其他肺部疾病区分开来或能预测疾病进程的。在将外周生物标志物应用于临床护理之前,需要进行高质量的研究来调查和验证RA-ILD中的外周生物标志物。
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