Reumathology Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain.
Rheumatology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
RMD Open. 2024 Jan 30;10(1):e003353. doi: 10.1136/rmdopen-2023-003353.
Real-world data regarding rheumatoid arthritis (RA) and its association with interstitial lung disease (ILD) is still scarce. This study aimed to estimate the prevalence of RA and ILD in patients with RA (RAILD) in Spain, and to compare clinical characteristics of patients with RA with and without ILD using natural language processing (NLP) on electronic health records (EHR).
Observational case-control, retrospective and multicentre study based on the secondary use of unstructured clinical data from patients with adult RA and RAILD from nine hospitals between 2014 and 2019. NLP was used to extract unstructured clinical information from EHR and standardise it into a SNOMED-CT terminology. Prevalence of RA and RAILD were calculated, and a descriptive analysis was performed. Characteristics between patients with RAILD and RA patients without ILD (RAnonILD) were compared.
From a source population of 3 176 165 patients and 64 241 683 EHRs, 13 958 patients with RA were identified. Of those, 5.1% patients additionally had ILD (RAILD). The overall age-adjusted prevalence of RA and RAILD were 0.53% and 0.02%, respectively. The most common ILD subtype was usual interstitial pneumonia (29.3%). When comparing RAILD versus RAnonILD patients, RAILD patients were older and had more comorbidities, notably concerning infections (33.6% vs 16.5%, p<0.001), malignancies (15.9% vs 8.5%, p<0.001) and cardiovascular disease (25.8% vs 13.9%, p<0.001) than RAnonILD. RAILD patients also had higher inflammatory burden reflected in more pharmacological prescriptions and higher inflammatory parameters and presented a higher in-hospital mortality with a higher risk of death (HR 2.32; 95% CI 1.59 to 2.81, p<0.001).
We found an estimated age-adjusted prevalence of RA and RAILD by analysing real-world data through NLP. RAILD patients were more vulnerable at the time of inclusion with higher comorbidity and inflammatory burden than RAnonILD, which correlated with higher mortality.
关于类风湿关节炎（RA）及其与间质性肺病（ILD）的关联的真实世界数据仍然很少。本研究旨在估计西班牙 RA 患者中 RA 和 ILD 的患病率，并使用电子健康记录（EHR）中的自然语言处理（NLP）比较有和无 ILD 的 RA 患者的临床特征。
这是一项基于 2014 年至 2019 年 9 家医院的成年 RA 和 RAILD 患者的二次使用非结构化临床数据的观察性病例对照、回顾性和多中心研究。使用 NLP 从 EHR 中提取非结构化临床信息，并将其标准化为 SNOMED-CT 术语。计算 RA 和 RAILD 的患病率，并进行描述性分析。比较有 RAILD 和无 ILD 的 RA 患者（RAnonILD）之间的特征。
在 3176165 名患者和 64241683 份 EHR 中，共发现 13958 名 RA 患者。其中，5.1%的患者还患有 ILD（RAILD）。总体年龄调整后的 RA 和 RAILD 患病率分别为 0.53%和 0.02%。最常见的ILD 亚型为寻常性间质性肺炎（29.3%）。当比较 RAILD 与 RAnonILD 患者时，RAILD 患者年龄更大，合并症更多，特别是感染（33.6% vs 16.5%，p<0.001）、恶性肿瘤（15.9% vs 8.5%，p<0.001）和心血管疾病（25.8% vs 13.9%，p<0.001）比 RAnonILD 更多。RAILD 患者的炎症负担也更高，反映在更多的药物治疗处方和更高的炎症参数上，并且住院死亡率更高，死亡风险更高（HR 2.32；95%CI 1.59 至 2.81，p<0.001）。
通过使用自然语言处理分析真实世界数据，我们估计 RA 和 RAILD 的年龄调整患病率。与 RAnonILD 相比，RAILD 患者在纳入时更脆弱，合并症和炎症负担更高，这与更高的死亡率相关。
