The impact of disease severity measures on survival in U.S. veterans with rheumatoid arthritis-associated interstitial lung disease

Author:

Brooks Rebecca1,Baker Joshua F2,Yang Yangyuna1,Roul Punyasha1,Kerr Gail S3,Reimold Andreas M4,Kunkel Gary5,Wysham Katherine D6ORCID,Singh Namrata6,Lazaro Deana7,Monach Paul A8,Poole Jill A9,Ascherman Dana P10,Mikuls Ted R1,England Bryant R1ORCID

Affiliation:

1. VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center , Omaha, NE

2. Corporal Michael J. Crescenz VA and Division of Rheumatology, University of Pennsylvania , Philadelphia, PA

3. Division of Rheumatology, Washington DC VA, Howard University and Georgetown University , Washington, DC

4. Dallas VA and Division of Rheumatic Diseases, University of Texas Southwestern , Dallas, TX

5. VA Salt Lake City and Division of Rheumatology, University of Utah , Salt Lake City, UT

6. VA Puget Sound Health Care System and Division of Rheumatology, University of Washington , Seattle, WA

7. Brooklyn VA , Brooklyn, NY

8. Boston VA , Boston, MA

9. Division of Allergy & Immunology, University of Nebraska Medical Center , Omaha, NE

10. Pittsburgh VA and Division of Rheumatology and Clinical Immunology, University of Pittsburgh , Pittsburgh, PA, USA

Abstract

Abstract Objectives To determine whether RA and interstitial lung disease (ILD) severity measures are associated with survival in patients with RA-ILD. Methods We studied US veterans with RA-ILD participating in a multicentre, prospective RA cohort study. RA disease activity (28-joint DAS [DAS28-ESR]) and functional status (multidimensional HAQ [MDHAQ]) were collected longitudinally while pulmonary function tests (forced vital capacity [FVC], diffusing capacity for carbon monoxide) were obtained from medical records. Vital status and cause of death were determined from the National Death Index and administrative data. Predictors of death were assessed using multivariable Cox regression models adjusting for age, sex, smoking status, ILD duration, comorbidity burden and medications. Results We followed 227 RA-ILD participants (93% male and mean age of 69 years) over 1073 person-years. Median survival after RA-ILD diagnosis was 8.5 years. Respiratory diseases (28%) were the leading cause of death, with ILD accounting for 58% of respiratory deaths. Time-varying DAS28-ESR (adjusted hazard ratio [aHR] 1.21; 95% CI: 1.03, 1.41) and MDHAQ (aHR 1.85; 95% CI: 1.29, 2.65) were separately associated with mortality independent of FVC and other confounders. Modelled together, the presence of either uncontrolled disease activity (moderate/high DAS28-ESR) or FVC impairment (<80% predicted) was significantly associated with mortality risk. Those with a combination of moderate/high disease activity and FVC <80% predicted had the highest risk of death (aHR 4.43; 95% CI: 1.70, 11.55). Conclusion Both RA and ILD disease severity measures are independent predictors of survival in RA-ILD. These findings demonstrate the prognostic value of monitoring the systemic features of RA-ILD.

Funder

Department of Veterans Affairs

Rheumatology Research Foundation

Scientist Development Award

Department of Defense

National Institutes of General Medical Sciences

National Institute for Occupational Safety and Health

American Heart Association

NIH

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Rheumatology

Reference43 articles.

1. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study;Bongartz;Arthritis Rheum,2010

2. Rheumatoid arthritis-related interstitial lung disease: associations, prognostic factors and physiological and radiological characteristics—a large multicentre UK study;Kelly;Rheumatology (Oxford),2014

3. Interstitial lung disease has a poor prognosis in rheumatoid arthritis: results from an inception cohort;Koduri;Rheumatology (Oxford),2010

4. Rheumatoid arthritis-interstitial lung disease-associated mortality;Olson;Am J Respir Crit Care Med,2011

5. Interstitial lung disease in recent onset rheumatoid arthritis;Gabbay;Am J Respir Crit Care Med,1997

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3