类风湿关节炎间质性肺疾病的危险因素：一项来自KOBIO注册研究的队列研究

Risk factors for interstitial lung disease in rheumatoid arthritis: a cohort study from the KOBIO registry.

作者信息

Min Hong Ki, Kim Se Hee, Lee Sang-Heon, Kim Hae-Rim

机构信息

Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Gwangjin-gu, Seoul, Republic of Korea.

Department of Rheumatology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.

出版信息

Ther Adv Musculoskelet Dis. 2023 Dec 30;16:1759720X231218098. doi: 10.1177/1759720X231218098. eCollection 2024.

DOI:10.1177/1759720X231218098

PMID:39156663

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11327977/

Abstract

BACKGROUND

Interstitial lung disease (ILD) is a critical extra-articular manifestation of rheumatoid arthritis (RA). However, little is known about the risk factors of RA-ILD.

OBJECTIVES

Here, we examined the effect of demographic, clinical, therapeutic, and environmental factors on the incidence of ILD in RA patients using the Korean College of Rheumatology Biologics and Targeted Therapy (KOBIO) registry.

DESIGN

We used data from the KOBIO registry, a multi-center, prospective, observational cohort that included RA patients in South Korea.

METHODS

RA patients who used biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) or conventional synthetic (cs)DMARDs, and were enrolled in the KOBIO registry, were examined. Demographic, clinical, and radiographic characteristics, as well as medications, were recorded at baseline and annually thereafter. Kaplan-Meier curves and the log-rank test were used to compare the incidence of ILD between RA patients taking different b/tsDMARDs. Hazard ratios (HRs) were calculated by Cox regression analyses.

RESULTS

In total, 2492 patients (1967 in the b/tsDMARDs group and 525 in the csDMARDs group) were analyzed. The b/tsDMARDs group showed longer disease duration, higher erythrocyte sedimentation rate/C-reactive protein, and higher disease activity score-28 (DAS28) than the csDMARDs group. The incidence of ILD was significantly higher in those taking tumor necrosis factor inhibitors and abatacept than in those taking csDMARDs (log ranked < 0.001). Multivariate Cox regression analysis identified older age (HR = 1.057, = 0.001), male sex (HR = 2.824, = 0.007), time-averaged DAS28 (HR = 2.241, < 0.001), and rheumatoid factor titer (HR = 1.009, = 0.007) as having a significantly increased HR for ILD occurrence.

CONCLUSION

ILD is a rare but critical extra-articular symptom of RA patients. Therefore, RA patients with the above risk factors should be monitored carefully for ILD development.

摘要

背景

间质性肺疾病（ILD）是类风湿关节炎（RA）一种重要的关节外表现。然而，关于类风湿关节炎相关间质性肺疾病（RA-ILD）的危险因素知之甚少。

目的

在此，我们使用韩国风湿病学会生物制剂和靶向治疗（KOBIO）登记处的数据，研究人口统计学、临床、治疗和环境因素对类风湿关节炎（RA）患者间质性肺疾病（ILD）发病率的影响。

设计

我们使用了KOBIO登记处的数据，这是一个多中心、前瞻性、观察性队列研究，纳入了韩国的类风湿关节炎患者。

方法

对使用生物制剂或靶向合成改善病情抗风湿药物（b/tsDMARDs）或传统合成（cs）DMARDs且纳入KOBIO登记处的类风湿关节炎患者进行研究。在基线时以及此后每年记录人口统计学、临床和影像学特征以及用药情况。使用Kaplan-Meier曲线和对数秩检验比较服用不同b/tsDMARDs的类风湿关节炎患者间质性肺疾病（ILD）的发病率。通过Cox回归分析计算风险比（HRs）。

结果

总共分析了2492例患者（b/tsDMARDs组1967例，csDMARDs组525例）。b/tsDMARDs组的病程更长，红细胞沉降率/C反应蛋白更高，疾病活动评分-28（DAS28）更高。与服用csDMARDs的患者相比，服用肿瘤坏死因子抑制剂和阿巴西普的患者间质性肺疾病（ILD）的发病率显著更高（对数秩检验P＜0.001）。多变量Cox回归分析确定年龄较大（HR = 1.057，P = 0.001）、男性（HR = 2.824，P = 0.007）、时间平均DAS28（HR = 2.241，P＜0.001）和类风湿因子滴度（HR = 1.009，P = 0.007）是间质性肺疾病（ILD）发生风险比显著增加的因素。