Highlights
- •RA-ILD could develop acute exacerbation (AE) during the clinical course.
- •The AE of RA-ILD was not uncommon as well as that of IPF.
- •AE is the most frequent cause of death in RA-ILD and IPF.
- •Low %DLCO and hypoalbuminemia were predictive factors of AE in RA-ILD.
- •The prognosis after AE of RA-ILD was significantly better than that of IPF.
Abstract
Background
Several studies have reported that acute exacerbation (AE), which occurs during the
clinical course of idiopathic pulmonary fibrosis (IPF), also occurs in rheumatoid
arthritis–associated interstitial lung disease (RA-ILD). However, the incidence, clinical
features, and risk factors for AE, a major cause of death of RA-ILD patients, and
the differences in clinical aspects of AE between RA-ILD and IPF have yet to be fully
understood.
Methods
We retrospectively reviewed data on 149 RA-ILD patients and 305 IPF patients. We investigated
the frequency of AE and compared the clinical data between RA-ILD with and without
AE to clarify the risk factor for AE. We also compared the post-AE prognosis and cause
of death between RA-ILD and IPF patients.
Results
Twenty-seven (18.1%) RA-ILD patients and 84 (27.5%) IPF patients developed AE. The
median survival time (MST) after AE of RA-ILD and IPF was 277 days and 60 days, respectively
(log rank, p = 0.038). In a multivariate analysis, hypoalbuminemia [odds ratio (O.R.) 0.090 (95%CI
0.011–0.733), p = 0.012] and % carbon monoxide diffusion capacity (%DLCO) [O.R. 0.810 (95%CI 0.814–0.964), p < 0.01] were independent risk factors for AE. AE was the most frequent cause of death
of RA-ILD and IPF.
Conclusion
RA-ILD patients could develop AE, and AE was not uncommon in RA-ILD or IPF. %DLCO and hypoalbuminemia were predictive factors of AE in RA-ILD. The prognosis after
AE of RA-ILD was significantly better than that of IPF. The most frequent cause of
death in RA-ILD and IPF was AE.
Keywords
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Article info
Publication history
Published online: June 03, 2022
Accepted:
June 1,
2022
Received in revised form:
April 17,
2022
Received:
January 24,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
