Lee Kyung-Ann, Kim Bo Young, Kim Sung Soo, Cheon Yun Hong, Kim Sang-Hyon, Jung Jae Hyun, Kim Geun-Tae, Hur Jin-Wuk, Lee Myeung-Su, Chung Chong Hyuk, Kim Yun Sung, Hong Seung-Jae, Kim Hae-Rim, Min Hong Ki, Kim Se Hee, Moon Su-Jin, Chang Sung Hae, Im Soojin, Nam Bo Da, Kim Hyun-Sook
Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung 25440, Republic of Korea.
Diagnostics (Basel). 2025 Mar 21;15(7):800. doi: 10.3390/diagnostics15070800.
: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) significantly affects disease prognosis and patient survival. The impact of conventional synthetic DMARDs (csDMARDs) and biologic/targeted synthetic DMARDs (b/tsDMARDs) on RA-ILD prognoses remains unclear. This study aimed to investigate the effects of csDMARDs and b/tsDMARDs on RA-ILD progression and prognosis based on pulmonary function tests (PFTs), high-resolution computed tomography (HRCT), and symptom changes. : This multicenter, retrospective, observational study included patients with RA-ILD at 13 referral hospitals in South Korea. The participants were categorized into csDMARD-only and b/tsDMARD-exposed groups. RA-ILD prognosis was assessed over a 24-month follow-up period using serial PFTs (the forced vital capacity [FVC] and diffusing capacity of the lungs for carbon monoxide [DLCO]), HRCT findings, and clinical symptom changes. Kaplan-Meier survival analyses and Cox proportional hazards models were used to compare disease progression risk while adjusting for baseline lung function, RA disease activity, and glucocorticoid use. : Among 127 eligible patients, 22 (17.3%) were exposed to b/tsDMARDs, predominantly abatacept and tocilizumab. During a mean follow-up of 2.8 years, 65 (51.2%) patients experienced RA-ILD progression. A higher baseline Disease Activity Score-28 with erythrocyte sedimentation rate (DAS28-ESR) (adjusted hazard ratio [aHR]: 1.344, 95% confidence interval [CI]: 1.136-1.590, = 0.001) and initially prescribed prednisone dose (aHR: 1.078, 95% CI: 1.011-1.151, = 0.023) were significant prognostic factors for ILD progression. No statistically significant difference in progression risk was observed between the csDMARD-only and b/tsDMARD-exposed groups (aHR: 0.937, = 0.851). : The RA-ILD prognosis was more strongly influenced by disease activity, rather than the type of DMARD used. These findings emphasize the importance of maintaining low RA disease activity to improve RA-ILD prognosis.
类风湿关节炎相关间质性肺疾病（RA - ILD）显著影响疾病预后和患者生存率。传统合成改善病情抗风湿药（csDMARDs）和生物/靶向合成改善病情抗风湿药（b/tsDMARDs）对RA - ILD预后的影响尚不清楚。本研究旨在基于肺功能测试（PFTs）、高分辨率计算机断层扫描（HRCT）和症状变化，探讨csDMARDs和b/tsDMARDs对RA - ILD进展和预后的影响。
本多中心、回顾性、观察性研究纳入了韩国13家转诊医院的RA - ILD患者。参与者被分为仅使用csDMARDs组和暴露于b/tsDMARDs组。通过连续的PFTs（用力肺活量[FVC]和肺一氧化碳弥散量[DLCO]）、HRCT结果和临床症状变化，在24个月的随访期内评估RA - ILD预后。使用Kaplan - Meier生存分析和Cox比例风险模型比较疾病进展风险，同时调整基线肺功能、RA疾病活动度和糖皮质激素使用情况。
在127例符合条件的患者中，22例（17.3%）暴露于b/tsDMARDs，主要是阿巴西普和托珠单抗。在平均2.8年的随访期间，65例（51.2%）患者出现RA - ILD进展。较高的基线红细胞沉降率28关节疾病活动评分（DAS28 - ESR）（调整后风险比[aHR]：1.344，95%置信区间[CI]：1.136 - 1.590，P = 0.001）和初始处方泼尼松剂量（aHR：1.078，95%CI：1.011 - 1.151，P = 0.023）是ILD进展的显著预后因素。仅使用csDMARDs组和暴露于b/tsDMARDs组之间在进展风险上未观察到统计学显著差异（aHR：0.937，P = 0.851）。
RA - ILD预后受疾病活动度的影响比所用DMARDs类型更强。这些发现强调了维持低RA疾病活动度对改善RA - ILD预后的重要性。
