Common Interstitial Pneumonia in Rheumatoid Arthritis Associated with Higher Mortality

The average age of onset of the condition is 65 years, but there are clinical exceptions that are being studied.

Interstitial lung disease associated with rheumatoid arthritis associated with decreased survival compared to the general population and radiographic pattern pneumonia A common interstitial tumor increases the risk of death independently of other factors, according to a Spanish study published in BMC Pulmonary Medicine.

A meta-analysis already suggested that a pattern pneumonia Regular interstitial appears to be associated with a higher risk of mortality compared with other patterns, however, it shows considerable heterogeneity with variable methodological quality among the included studies.

Given this situation, it is important to know what factors may affect survival in order to assess prognosis.

Dr. Francisco Javier Narvaez, spokesperson for the Spanish Society of Rheumatology and rheumatologist at Belvitgue University Hospital in Barcelona, ​​commented: rheumatoid arthritis It is a complex clinical situation due to its frequency and potential severity, as well as the difficulty associated with therapeutic management. Therefore, in all cases, multidisciplinary supervision by a rheumatologist and a pulmonologist is recommended, which will undoubtedly lead to better care for these patients.”

“Development of lung involvement rheumatoid arthritis associated with persistent moderate or high disease activity. That is why controlling the activity of rheumatic disease has been shown to prevent and improve the prognosis of lung disease,” said the rheumatologist.

Mortality and radiographic patterns

The primary objective of the study was to analyze all-cause mortality obtained from the records of the two hospitals.

radiographic patterns of interstitial lung disease assocd rheumatoid arthritis initially based on high-resolution computed tomography images; pneumonia common interstitial, non-specific, etc. (pneumonia organized crypto and more pneumonia idiopathic interstitial). As well as sociodemographic, clinical, laboratory and disease duration characteristics.

High specific mortality rate

Forty-seven patients were included and the mean follow-up was 5.3 ± 2.7 years, with a total follow-up of 242 patient-years and a maximum of 12 years. Most of the patients (89.4%) were diagnosed rheumatoid arthritis preceded by interstitial lung disease.

It pneumonia Normal interstitial was the most frequent, followed by nonspecific. The pattern after adjustment for confounding factors pneumonia regular interstitial was associated with an increased risk of mortality compared with regularity pneumonia non-specific interstitial.

As for the overall standardized mortality rate, it was 2.57, resulting in an excess of patient mortality compared to the general population. Men and women, as well as those aged 75 to 84, showed excess mortality, while the effect disappeared at age 85. After stratifying by age and sex, women aged 60 to 75 years were the group with the highest standardized mortality rate.

The estimated incidence of all-cause mortality was 64.3 (39.4 to 104.9) per 1000 patient-years. After diagnosis of interstitial lung disease, patients were death-free for up to 1.5 years, with 10% mortality at 3 years, 30% at 6 years, and 50% at 8.3 years after diagnosis. Regarding deaths directly attributable to interstitial lung disease, the specific incidence was 41.4 (22.3 to 76.9), with a median survival of 10.9 years.

Death occurred in 16 patients (34%) during the study. The most frequent cause was progression, same or acute exacerbation of interstitial lung disease pneumonia (62.5%), followed by abdominal sepsis (12.5%), one due to neoplasia, one due to cardiac disease and one due to cognitive impairment.

Predictors of progression

Major predictors of functional progression in diffuse interstitial lung disease were identified pneumonia interstitial tissue, elevated anti-cyclic citrullinated peptide antibody titers, baseline Diffuse Pulmonary Carbon Monoxide (DLCO) impairment, greater than or equal to 10% decrease in forced vital capacity during follow-up, extensive lung involvement – computed tomography of the chest and interleukin-6 and Elevated serum levels of Krebs von den Lungen glycoprotein-6 (KL-6).

All patients were enrolled from the time of diagnosis and were followed up by the multidisciplinary pulmonary autoimmune interstitial rheumatology units, attended by a tandem of pulmonologists and rheumatologists.