类风湿关节炎相关间质性肺疾病急性加重的发生率、风险因素和预后：系统评价和荟萃分析。
Incidence, risk factors, and prognosis of acute exacerbation of rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis.
机构信息
Department of Rheumatology and Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
出版信息
BMC Pulm Med. 2023 Jul 11;23(1):255. doi: 10.1186/s12890-023-02532-2.
INTRODUCTION
Acute exacerbation (AE) is a devastating complication of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and leads to high mortality. This study aimed to investigate the incidence, risk factors, and prognosis of acute exacerbation of rheumatoid arthritis-associated interstitial lung disease (AE-RA-ILD).
METHODS
PubMed, EMBASE, Web of Science, and Medline were searched through 8 February 2023. Two independent researchers selected eligible articles and extracted available data. The Newcastle Ottawa Scale was used to assess the methodological quality of studies used for meta-analysis. The incidence and prognosis of AE-RA-ILD were investigated. Weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) and pooled odds ratios (ORs) with 95% CIs were calculated to explore the risk factors of AE in RA-ILD.
RESULTS
Twenty-one of 1,589 articles were eligible. A total of 385 patients with AE-RA-ILD, of whom 53.5% were male, were included. The frequency of AE in patients with RA-ILD ranged from 6.3 to 55.6%. The 1-year and 5-year AE incidences were 2.6-11.1% and 11-29.4%, respectively. The all-cause mortality rate of AE-RA-ILD was 12.6-27.9% at 30 days and 16.7-48.3% at 90 days. Age at RA diagnosis (WMD: 3.61, 95% CI: 0.22-7.01), male sex (OR: 1.60, 95% CI:1.16-2.21), smoking (OR: 1.50, 95% CI: 1.08-2.08), lower forced vital capacity predicted (FVC%; WMD: -8.63, 95% CI: -14.68 to - 2.58), and definite usual interstitial pneumonia (UIP) pattern (OR: 1.92, 95% CI: 1.15-3.22) were the risk factors of AE-RA-ILD. Moreover, the use of corticosteroids, methotrexate, and biological disease-modifying anti-rheumatic drugs, was not associated with AE-RA-ILD.
CONCLUSION
AE-RA-ILD was not rare and had a poor prognosis. Age at RA diagnosis, male sex, smoking, lower FVC%, and definite UIP pattern increased the risk of AE-RA-ILD. The use of medications, especially methotrexate and biological disease-modifying anti-rheumatic drugs, may not be related to AE-RA-ILD.
REGISTRATION
CRD42023396772.
简介
急性加重（AE）是类风湿关节炎相关间质性肺疾病（RA-ILD）的一种毁灭性并发症，导致高死亡率。本研究旨在探讨类风湿关节炎相关间质性肺疾病（AE-RA-ILD）急性加重的发生率、危险因素和预后。
方法
通过 2023 年 2 月 8 日检索 PubMed、EMBASE、Web of Science 和 Medline，筛选出合格的文章，并提取可用数据。使用纽卡斯尔-渥太华量表评估用于荟萃分析的研究的方法学质量。研究了 AE-RA-ILD 的发生率和预后。使用加权均数差（WMD）及其相应的 95%置信区间（CI）和合并优势比（OR）及其 95%CI 来探讨 RA-ILD 中 AE 的危险因素。
结果
1589 篇文章中有 21 篇符合条件。共纳入 385 例 AE-RA-ILD 患者，其中 53.5%为男性。RA-ILD 患者中 AE 的频率为 6.3%至 55.6%。1 年和 5 年的 AE 发生率分别为 2.6%至 11.1%和 11%至 29.4%。AE-RA-ILD 的全因死亡率在 30 天时为 12.6%至 27.9%，在 90 天时为 16.7%至 48.3%。RA 诊断时的年龄（WMD：3.61，95%CI：0.22-7.01）、男性（OR：1.60，95%CI：1.16-2.21）、吸烟（OR：1.50，95%CI：1.08-2.08）、预测用力肺活量（FVC%）较低（WMD：-8.63，95%CI：-14.68 至-2.58）和明确的寻常型间质性肺炎（UIP）模式（OR：1.92，95%CI：1.15-3.22）是 AE-RA-ILD 的危险因素。此外，使用皮质类固醇、甲氨蝶呤和生物改善病情抗风湿药物与 AE-RA-ILD 无关。
结论
AE-RA-ILD 并不少见，预后不良。RA 诊断时的年龄、男性、吸烟、FVC%较低和明确的 UIP 模式增加了 AE-RA-ILD 的风险。药物的使用，尤其是甲氨蝶呤和生物改善病情抗风湿药物，可能与 AE-RA-ILD 无关。
注册
CRD42023396772。
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