Karadag Duygu Temiz, Dogan Sevtap, Gokcen Neslihan, Cagdas Oznur Sadioglu, Yazici Ayten, Cefle Ayse
Division of Rheumatology, Department of Internal Medicine, Kocaeli University Faculty of Medicine, İzmit, Kocaeli, 41380, Turkey.
Department of Radiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
Adv Rheumatol. 2025 Jan 25;65(1):5. doi: 10.1186/s42358-025-00435-w.
The clinical manifestations and course of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) exhibits considerable heterogeneity. In this study, we aimed to explore radiographic progression over a defined period, employing the Warrick score as a semi-quantitative measure in early RA-ILD, and to assess the associated risk factors for progression.
RA-ILD patients underwent consecutive Warrick scoring based on initial high-resolution computed tomography (HRCT) at diagnosis and the first follow-up. Associations between Warrick scores, pulmonary function tests, and patient characteristics were analyzed. The ROC curve assessed the predictive performance of the Warrick score change rate for ILD progression, while multivariable logistic regression analysis identified risk factors for progression.
Significant correlations were found between Warrick scores and age at RA-ILD diagnosis, age at ILD diagnosis, and baseline DAS28-ESR. For the severity score, correlations were r = 0.359, r = 0.372, and r = 0.298 (p = 0.001, p < 0.001, p = 0.014, respectively); for the extent score, r = 0.364, r = 0.318, and r = 0.255 (p = 0.001, p = 0.005, p = 0.038, respectively); and for the total score, r = 0.376, r = 0.367, and r = 0.280 (p < 0.001, p = 0.001, p = 0.022, respectively). Annual changes in severity, extent, and total Warrick scores showed sensitivities of 91-97% and specificities of 98% for predicting progression over a 5-year follow-up. Cut-off values were 0.0278 for the severity score (AUC 0.954), 0.0227 for extent score (AUC 0.976), and 0.0694 for total score (AUC 0.946). Warrick severity, extent, and total scores increased significantly during follow-up. Age > 50 years (OR 7.7; p = 0.028) and baseline usual interstitial pneumonia (UIP) pattern (OR 3.1, p = 0.041) were identified as risk factors for progression.
Advanced age and UIP pattern were significant risk factors for progression. Warrick scoring may may help predict progression in RA-ILD, particularly through changes in severity, extent, and total scores. Due to the retrospective design and small sample size, further prospective studies with larger cohorts are needed to confirm these findings and validate Warrick scoring as a reliable marker for RA-ILD progression.
类风湿关节炎相关间质性肺疾病（RA - ILD）的临床表现和病程具有显著的异质性。在本研究中，我们旨在探讨在一段特定时期内的影像学进展情况，采用沃里克评分作为早期RA - ILD的半定量指标，并评估进展的相关危险因素。
RA - ILD患者在诊断时及首次随访时基于初始高分辨率计算机断层扫描（HRCT）进行连续的沃里克评分。分析沃里克评分、肺功能测试和患者特征之间的关联。ROC曲线评估沃里克评分变化率对ILD进展的预测性能，而多变量逻辑回归分析确定进展的危险因素。
发现沃里克评分与RA - ILD诊断时的年龄、ILD诊断时的年龄以及基线DAS28 - ESR之间存在显著相关性。对于严重程度评分，相关性分别为r = 0.359、r = 0.372和r = 0.298（p = 0.001、p < 0.001、p = 0.014）；对于范围评分，r = 0.364、r = 0.318和r = 0.255（p = 0.001、p = 0.005、p = 0.038）；对于总分，r = 0.376、r = 0.367和r = 0.280（p < 0.001、p = 0.001、p = 0.022）。在5年随访中，严重程度、范围和沃里克总分的年度变化对预测进展的敏感性为91 - 97%，特异性为98%。严重程度评分的截断值为0.0278（AUC 0.954），范围评分为0.0227（AUC 0.976），总分为0.0694（AUC 0.946）。随访期间沃里克严重程度、范围和总分显著增加。年龄>50岁（OR 7.7；p = 0.028）和基线普通型间质性肺炎（UIP）模式（OR 3.1，p = 0.041）被确定为进展的危险因素。
高龄和UIP模式是进展的重要危险因素。沃里克评分可能有助于预测RA - ILD的进展，特别是通过严重程度、范围和总分的变化。由于本研究为回顾性设计且样本量较小，需要进一步开展更大队列的前瞻性研究来证实这些发现，并验证沃里克评分作为RA - ILD进展可靠标志物的有效性。
