Marcoux Veronica, Lok Stacey, Mondal Prosanta, Assayag Deborah, Fisher Jolene H, Shapera Shane, Morisset Julie, Manganas Hélène, Fell Charlene D, Hambly Nathan, Cox P Gerard, Kolb Martin, Gershon Andrea S, To Teresa, Sadatsafavi Mohsen, Khalil Nasreen, Wong Alyson W, Wilcox Pierce G, Ryerson Christopher J, Johannson Kerri A
Department of Medicine, University of Saskatchewan, Saskatoon, Canada.
Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, Canada.
J Thorac Dis. 2023 May 30;15(5):2517-2527. doi: 10.21037/jtd-22-1820. Epub 2023 May 12.
Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is challenging to manage, with a paucity of robust data to guide treatment. Our aim was to characterize the pharmacologic treatment of RA-ILD utilizing a retrospective design in a national multi-center prospective cohort, and to identify associations between treatment and change in lung function and survival.
Patients with RA-ILD and a radiological pattern of non-specific interstitial pneumonia (NSIP) or usual interstitial pneumonia (UIP) were included. Unadjusted and adjusted linear mixed models and Cox proportional hazards models were used to compare lung function change and risk of death or lung transplant by radiologic patterns and treatment.
Of 161 patients with RA-ILD, UIP pattern was more common than NSIP (55.9% 44.1%). Only 44/161 (27%) patients were treated over median follow-up of 4 years with medication choice appearing unrelated to patient-specific variables. Decline in forced vital capacity (FVC) was not associated with treatment. Patients with NSIP had lower risk of death or transplant, compared to UIP (P=0.0042). In patients with NSIP, there was no difference in time to death or transplant comparing treated to untreated in adjusted models [hazard ratio (HR) =0.73; 95% confidence interval (CI): 0.15-3.62; P=0.70]. Similarly, in patients with UIP, there was no difference in time to death or lung transplant between treated and untreated in adjusted models (HR =1.06; 95% CI: 0.49-2.28; P=0.89).
Treatment of RA-ILD is heterogeneous, with most patients in this cohort not receiving treatment. Patients with UIP had worse outcomes compared to NSIP, similar to other cohorts. Randomized clinical trials are needed to inform pharmacologic therapy in this patient population.
类风湿关节炎相关间质性肺疾病（RA-ILD）的管理颇具挑战性，缺乏有力数据来指导治疗。我们的目的是利用全国多中心前瞻性队列的回顾性设计来描述RA-ILD的药物治疗情况，并确定治疗与肺功能变化及生存率之间的关联。
纳入具有非特异性间质性肺炎（NSIP）或普通间质性肺炎（UIP）放射学模式的RA-ILD患者。采用未调整和调整后的线性混合模型以及Cox比例风险模型，通过放射学模式和治疗方法比较肺功能变化以及死亡或肺移植风险。
在161例RA-ILD患者中，UIP模式比NSIP更常见（55.9%对44.1%）。在4年的中位随访期内，只有44/161（27%）的患者接受了治疗，药物选择似乎与患者特定变量无关。用力肺活量（FVC）下降与治疗无关。与UIP患者相比，NSIP患者的死亡或移植风险较低（P=0.0042）。在调整模型中，NSIP患者中，治疗组与未治疗组在死亡或移植时间上没有差异[风险比（HR）=0.73；95%置信区间（CI）：0.15-3.62；P=0.70]。同样，在UIP患者中，调整模型中治疗组与未治疗组在死亡或肺移植时间上也没有差异（HR =1.06；95%CI：0.49-2.28；P=0.89）。
RA-ILD的治疗具有异质性，该队列中的大多数患者未接受治疗。与NSIP患者相比，UIP患者的预后更差，这与其他队列相似。需要进行随机临床试验，为该患者群体的药物治疗提供依据。
