THU0106 Identification of Markers Associated with The Occurrence of Interstitial Lung Disease in Rheumatoid Arthritis Patients
Authors: P.-A. Juge, L. Wemeau, S. Marchand-Adam, M.-P. Debray, H. Nunes, S. Gazal, S. Ottaviani, T. Schaeverbeke, N. Saindenberg, D. Valeyre, G. Thabut, M.-C. Boissier, L. Dunogeant, Y. Allanore, C. Richez, R.-M. Flipo, B. Wallaert, P. Richette, V. Cottin, J. Sibilia, R. Borie, B. Coustet, H. Liote, M. Soubrier, A. Frazier, B. Crestani, P. Dieude
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Rheumatoid arthritis (RA) is a systemic autoimmune disease, the most severe manifestation being interstitial lung disease (ILD). Therapeutic options are undefined and ILD is one of the leading causes of mortality for RA patients. A better characterization of RA-ILD–associated factors may improve the risk stratification of RA patients. <h3>Objectives</h3> To identify variables associated with ILD occurrence in RA. <h3>Methods</h3> RA-ILD patients (RA-ILD+) in a French multicentric cohort were compared to monocentric RA cases without ILD (RA-ILD-). All patients fulfilled 2010 ACR/EULAR criteria for RA and had a HRCT chest scan for suspected ILD or during a pre-biologic assessment. ILD was defined by HRCT results. Because ILD occurrence increases with RA duration, RA-ILD+ and RA-ILD- patients were matched by disease duration (1:1). Demographic data, clinical features of RA and treatment modalities before the ILD diagnosis were collected. Results significant on univariate analysis (P&lt;0.15) were selected for multivariate analysis to identify variables independently associated with RA-ILD. Duration of methotrexate (MTX) and anti-TNF agent use was adjusted to mean MTX or anti-TNF duration before ILD diagnosis. <h3>Results</h3> Among 253 consecutive RA patients, 81 were male (32.02%), 112 (48.07%) were smokers, mean age at RA onset was 48.11 ± 16.33 years, and mean RA duration 11.69 ± 10.10 years; 199 patients (85.78%) were ACPA-positive and 171 (71.85%) had erosive status; 134 (60.63%) received MTX and 63 (28.25%) a TNF inhibitor. Among the 253 patients, 138 (54.55%) had ILD. Among the RA-ILD+ patients, 72 (74.23%) had UIP and 25 (25.77%) NSIP. On univariate analysis, ILD was associated with older age at RA onset (52.69 ± 15.00 <i>vs</i> 42.86 ± 16.26 years, P=0.0001), male sex (40.68% <i>vs</i> 21.74%, P=0.001), ACPA rate ≥60 N (20.63% <i>vs</i> 6.41%, P=0.012), less use of anti-TNF agents and MTX (14.55% <i>vs</i> 41.59%, P=0.001, and 50.94% <i>vs</i> 69.57, P=0.005, respectively) and lower MTX dosage (15.26 ± 4.44 <i>vs</i> 16.83 ± 4.31 mg/week, P=0.046). There was no difference for erosive status. On multivariate analysis, ILD was independently associated with older age at RA onset (<i>P</i>&lt;0.0001), male sex (<i>P</i>=0.0006), less use of MTX (<i>P</i>=0.015) with lower dosage (<i>P</i>=0.005) and less use of anti-TNF agents (<i>P</i>=0.004). <h3>Conclusions</h3> As previously reported, ILD was independently associated with male sex as well as older age at RA onset and, of interest, less use of MTX and anti-TNF biologics before ILD diagnosis, even though patients did not differ in erosive status. Larger prospective studies are required to further elucidate the role of DMARDs and anti-TNF biologics in ILD occurrence and progression in RA patients. <h3>Disclosure of Interest</h3> None declared