RESEARCH - Interstitial lung disease has a poor prognosis in RA: results from an inception cohort

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Rheumatology Advance Access originally published online on March 11, 2010

Rheumatology 2010 49(8):1483-1489; doi:10.1093/rheumatology/keq035

Interstitial lung disease has a poor prognosis in rheumatoid

arthritis: results from an inception cohort

Gouri Koduri1, Sam Norton2, Adam Young1, Nigel 1, Davies1, Joe

Devlin1, Josh Dixey1, Gough1, Prouse1, Winfield1,

1 on behalf of ERAS (Early Rheumatoid Arthritis Study)

1ERAS, Rheumatology Department, St Albans City Hospital, St Albans and

2Centre for Lifespan and Chronic Illness Research, University of

Hertfordshire, Hatfield, Hertfordshire, UK.

Abstract

Objectives. Pulmonary complications of RA are well described. Although

some are benign, interstitial lung disease (ILD) has a poor prognosis.

Few RA inception cohorts have reported the natural history of ILD

related to RA (RA-ILD). We examine its incidence, outcome and

prognostic indicators.

Methods. Extra-articular features and comorbidity have been recorded

yearly in a well-established inception cohort of RA with a 20-year

follow-up. Standard clinical, laboratory and radiological measures of

RA were recorded at baseline and yearly. Details of deaths were

provided by a national central register.

Results. Out of 1460 patients, 52 developed RA-ILD, half either at

baseline or within 3 years of onset. The annualized incidence was

4.1/1000 (95% CI 3.0, 5.4) and the 15-year cumulative incidence

62.9/1000 (95% CI 43.0, 91.7). Incidence of RA-ILD was associated with

older age, raised baseline ESR and HAQ. Evidence to implicate any drug

effect (e.g. MTX) was lacking. Of these patients, 39 died, attributed

to RA-ILD in 28. Median survival following diagnosis of RA-ILD was 3

years.

Conclusions. RA-ILD is an important and early feature of RA. It is

related to disease activity and has a poor prognosis. Further studies

are required to determine whether screening for pulmonary disease

would identify these patients at an earlier stage.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/49/8/1483?etoc

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