Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China.
BMJ Open Respir Res. 2024 Nov 17;11(1):e001817. doi: 10.1136/bmjresp-2023-001817.
This study aimed at identifying risk factors for the incidence of interstitial lung disease in patients with rheumatoid arthritis (RA-ILD) by a systematic review and meta-analysis.
: studies published by March 2021 were searched in PubMed, Web of Science, MEDLINE, EMBASE, Cochrane Library and Scopus databases. : cohort studies or nested case-control studies that reported OR or HR of risk factors for RA-ILD were included. Two researchers independently screened the studies and extracted data. : the relative risks (RRs) were introduced to measure the association across studies. : quality assessments of included studies were performed using the Newcastle-Ottawa Scale. Based on the result of heterogeneity, the random-effects model or fixed-effects model was chosen in the meta-analysis. Furthermore, a sensitivity analysis was conducted to identify the origins of heterogeneity, and publication bias was evaluated for the factors with no less than five included studies by funnel plots and Egger's test.
Among 3075 identified articles, 12 studies met the inclusion criteria. 17 risk factors were included in the meta-analysis. Male (RR 1.94, 95% CI 1.33 to 2.85, p<0.001), elder age (>60 years, RR 1.42, 95% CI 1.05 to 1.94, p=0.02), older RA onset age (RR 1.05, 95% CI 1.01 to 1.10, p=0.02), smoking (RR 1.37, 95% CI 1.09 to 1.71, p=0.006), lung complications (RR 2.72, 95% CI 1.24 to 5.95, p=0.01), rheumatoid nodule (RR 1.85, 95% CI 1.36 to 2.51, p<0.001), leflunomide usage (RR 1.41, 95% CI 1.02 to 1.96, p=0.04) were identified as risk factors of RA-ILD.
Physicians should be aware that patients with RA with the above risk factors are likely to develop RA-ILD, and perform close ILD screening during follow-ups so that the patients can be early diagnosed and treated, and achieve improved prognosis.
本研究通过系统回顾和荟萃分析，旨在确定类风湿关节炎（RA-ILD）患者发生间质性肺疾病（ILD）的危险因素。
检索 2021 年 3 月前在 PubMed、Web of Science、MEDLINE、EMBASE、Cochrane 图书馆和 Scopus 数据库发表的研究。纳入报告 RA-ILD 危险因素的队列研究或巢式病例对照研究。两名研究人员独立筛选研究并提取数据。采用相对风险（RR）来衡量研究间的相关性。使用纽卡斯尔-渥太华量表对纳入研究进行质量评估。根据异质性结果，选择随机效应模型或固定效应模型进行荟萃分析。此外，还进行了敏感性分析以确定异质性的来源，并通过漏斗图和 Egger 检验评估了纳入研究不少于 5 项的因素的发表偏倚。
在 3075 篇文章中，有 12 项研究符合纳入标准。荟萃分析纳入了 17 个危险因素。男性（RR 1.94，95%CI 1.33 至 2.85，p<0.001）、年龄较大（>60 岁，RR 1.42，95%CI 1.05 至 1.94，p=0.02）、类风湿关节炎发病年龄较大（RR 1.05，95%CI 1.01 至 1.10，p=0.02）、吸烟（RR 1.37，95%CI 1.09 至 1.71，p=0.006）、肺部并发症（RR 2.72，95%CI 1.24 至 5.95，p=0.01）、类风湿结节（RR 1.85，95%CI 1.36 至 2.51，p<0.001）、来氟米特使用（RR 1.41，95%CI 1.02 至 1.96，p=0.04）被确定为 RA-ILD 的危险因素。
医生应注意，具有上述危险因素的 RA 患者可能会发生 RA-ILD，并在随访期间进行密切的ILD 筛查，以便患者能够早期诊断和治疗，从而改善预后。
