类风湿关节炎或银屑病关节炎患者使用生物制剂治疗时的间质性肺病：来自 5 个北欧登记处的数据。

Interstitial Lung Disease in Patients With Rheumatoid Arthritis or Psoriatic Arthritis Initiating Biologics and Controls: Data From 5 Nordic Registries.

机构信息

S.A. Provan, MD, PhD, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, and Section of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway;

L. Ljung, MD, PhD, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, and Stockholm Health Service, Center for Rheumatology, Academic Specialist Center, Stockholm, Sweden.

出版信息

J Rheumatol. 2024 Nov 1;51(11):1111-1118. doi: 10.3899/jrheum.2024-0252.

DOI:10.3899/jrheum.2024-0252

PMID:39218450

Abstract

OBJECTIVE

Interstitial lung disease (ILD) is one of the most common pulmonary manifestations of rheumatoid arthritis (RA), but its prevalence has not been investigated in psoriatic arthritis (PsA). The role of methotrexate (MTX) in ILD development remains under debate. This study (1) compares the incidences of ILD in patients with RA or PsA initiating a first biologic disease-modifying antirheumatic drug (bDMARD) to that in the general population, and (2) investigates the role of MTX comedication on ILD incidence.

METHODS

Patients were identified in 5 rheumatology registries. Demographics, MTX use, and disease activity were retrieved. Matched subjects from the general population were available from 4 countries. Incidence of ILD during follow-up of up to 5 years was assessed through national patient registries. Subjects with prior ILD were excluded. Adjusted hazard ratios (HRs) were calculated for ILD incidence in patients vs the general population, and for MTX users vs nonusers.

RESULTS

During follow-up of 29,478 patients with RA and 10,919 patients with PsA initiating a first bDMARD and 362,087 population subjects, 225, 23, and 251 cases of ILD were identified, respectively. HRs for ILD (vs population subjects) were 9.7 (95% CI 7.97-11.91) in RA and 4.4 (95% CI 2.83-6.97) in PsA. HRs for ILD with MTX comedication (vs nonuse) were 1.0 (95% CI 0.72-1.25) in RA and 0.9 (95% CI 0.38-2.05) in PsA.

CONCLUSION

Among patients with RA and PsA initiating a bDMARD, the risk of ILD was higher than in the general population, and was highest in RA. MTX comedication was not a risk determinant for ILD.

摘要

目的

间质性肺病（ILD）是类风湿关节炎（RA）最常见的肺部表现之一，但在银屑病关节炎（PsA）中尚未对此进行研究。甲氨蝶呤（MTX）在ILD 发展中的作用仍存在争议。本研究（1）比较了起始使用首个生物改善病情抗风湿药（bDMARD）的 RA 或 PsA 患者ILD 的发生率与普通人群相比，（2）探讨了 MTX 联合用药对ILD 发生率的影响。

方法

在 5 个风湿病登记处中确定了患者。检索了人口统计学、MTX 使用情况和疾病活动情况。来自 4 个国家的普通人群中有匹配的研究对象。通过国家患者登记处评估了长达 5 年的随访期间ILD 的发生率。排除了有既往ILD 的患者。计算了患者与普通人群相比ILD 发生率的调整后的风险比（HR），以及 MTX 使用者与非使用者相比ILD 发生率的调整后的 HR。

结果

在 29478 例起始使用首个 bDMARD 的 RA 患者和 10919 例 PsA 患者以及 362087 例普通人群受试者的随访期间，分别确定了 225、23 和 251 例ILD 病例。ILD（与普通人群相比）的 HR 分别为 RA 9.7（95%CI7.97-11.91）和 PsA 4.4（95%CI2.83-6.97）。MTX 联合用药（与非使用相比）与 ILD 的 HR 分别为 RA 1.0（95%CI0.72-1.25）和 PsA 0.9（95%CI0.38-2.05）。