Rheumatoid Arthritis Patients at Risk for Interstitial Lung Disease

Study Overview
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Brief Summary
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The overall goal of this study is to define the phenotype of Interstitial Lung Disease (ILD), and identify factors that predict radiologic progression in those with subclinical RA-ILD, in patients with rheumatoid arthritis (RA). The investigators hypothesize that there are common core elements (e.g. clinical features, genetic variants, and/or biologic markers) between other forms of ILD (e.g. idiopathic pulmonary fibrosis, IPF) and subclinical RA-ILD that places individuals at risk for the development of lung disease.

Official Title
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Rheumatoid Arthritis Patients at Risk for Interstitial Lung Disease

Conditions
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Rheumatoid Arthritis, Interstitial Lung Disease

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ≥ 45years old Diagnosis of RA using the 2010 American College of Rheumatology (ACR) criteria Exclusion Criteria: Inability to give informed consent Pregnant women History of interstitial lung disease Evidence of other causes of diffuse parenchymal lung disease such as infection, drug toxicity, other autoimmune processes, etc. Subjects over the age of 90 years old or less than 45 years old

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| RA with Sub-clinical ILD<br>Subjects will be followed annually until study closure. Assessments are as follows: Clinical (Annual): Demographics, health-related behaviors, co-morbidities, medications, respiratory symptoms, rheumatologic assessment, quality of life Physiologic (3-5 yrs FU): Lung function on Pulmonary Function Test (PFT) Radiologic (3-5 yrs FU): HRCT scan of chest Genetic (3-5 yrs FU): Blood sample collection for RNA Biologic (3-5 yrs FU): Blood sample collection for other blood markers | |
| RA with No-ILD<br>Subjects will be followed annually until study closure. Assessments are as follows: Clinical (Annual): Demographics, health-related behaviors, co-morbidities, medications, respiratory symptoms, rheumatologic assessment, quality of life Physiologic (3-5 yrs FU): Lung function on Pulmonary Function Test (PFT) Radiologic (3-5 yrs FU): HRCT scan of chest Genetic (3-5 yrs FU): Blood sample collection for RNA Biologic (3-5 yrs FU): Blood sample collection for other blood markers Note: Certain follow-up procedures may not occur for every subject and will be determined by the research team. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Presence of interstitial lung disease on high resolution CT (HRCT) chest imaging | HRCT scans of the chest will be interpreted by two radiologists and the presence or absence of interstitial lung abnormality will be recorded. When present, abnormalities will be categorized as absent, equivocal, non-fibrotic, or fibrotic, and the extent of any reticular abnormalities will be graded on an 11-point scale (0, 1-10%, 11-20%, etc.). Additionally, the presence or absence of airway disease, centrilobular thickening, mosaic attenuation, and air trapping will be recorded. | 3-5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression of lung disease over time | Radiologic progression of lung disease will be determined through a comparison of baseline HRCT chest findings to follow-up HRCT chest findings at the 3-5 year follow-up benchmark. Similar to baseline, follow-up HRCT scans of the chest will be interpreted by 2 different radiologists. Quantitative radiologic progression will be defined as ≥ 10% increase in fibrotic changes from baseline to follow-up - additionally, the percent reticular change, percent honeycomb change, and percent traction bronchiectasis on the follow-up scan will be quantified and recorded. Radiologic findings of progression will be used in correlation with other clinical features to determine the clinical relevance of the change. The clinical features include - change in cough, change in dyspnea (as measured by UCSD shortness of breath questionnaire), change in FVC percent predicted value, the development of established RA-ILD, or respiratory-related death, over the same time period. | 3-5 Years | 
| Impact of subclinical RA-ILD on health-related quality of life in RA | The impact of subclinical RA-ILD on health-related quality of life will be measured using subjective patient questionnaires that will be completed at both baseline and follow-up. These questionnaires include - SF-36, St. George Respiratory Questionnaire, and Multi-Dimensional Health Assessment Questionnaire. | 3-5 Years | 
| Outcome of airways disease | Clinical outcomes will be measured through respiratory assessment (physical exam), changes is dyspnea (based on the University of California San Diego shortness of breath questionnaire), changes in FVC percent predicted values (based on pulmonary function testing), increase in cough (determined using a visual analog scale, where 10 is the worst cough and 0 is no cough), and development of RA-ILD requiring treatment. | 3-5 Years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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IPF, Rheumatoid Arthritis, RA, Interstitial Lung Disease, ILD, lung disease, connective tissue disease, CTD, idiopathic pulmonary fibrosis, airways disease