FRI0099 THE IMPACT OF BIOLOGICAL DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS ON THE COURSE OF RHEUMATOID ARTHRITIS-ASSOCIATED LUNG DISEASE
Authors: A. Köken Avşar, G. Can, M. Birlik, İ. Sari, F. Onen
Journal: Annals of the Rheumatic Diseases (2020)

Background: Pulmonary involvement is one of the frequent extra-articular manifestations of rheumatoid arthritis (RA) (1). Biological disease-modifying anti-rheumatic drugs (bDMARDs) are effectively used in the treatment of musculoskeletal findings of RA but their effect on RA-associated lung disease is unclear. Objectives: The aim of this retrospective study is to evaluate and compare different bDMARD treatments used in RA patients with RA-associated lung disease. Methods: All RA patients who received bDMARDs between 2008 and 2018 in a single rheumatology centre and had thorax high-resolution computed tomography (HRCT) were reviewed for the findings of lung involvement. Patients with positive finding were included in the study. Following the biologic treatment, whether there was a progression/regression in lung involvement was evaluated by comparing the baseline and the latest thorax HRCT findings. Clinical and laboratory data were collected from medical records. Results: A total of 40 patients (mean age:62.4 years; 72.5% women) were included in the study. Clinical and demographic characteristics of patients are summarized in Table 1. During the mean 107.43 ± 65 months follow-up period, HRCT findings remained stable in 31 patients (76%) and improved in one (2.5%), while 7 patients (17.5%) had progress in their lung involvement. When patients with and without progress were compared, lung involvement at the diagnosis of RA and the presence of respiratory symptoms at bDMARDs initation was found to be more frequent in the first group (p=0.023 and p=0.020, respectively). Mean ESH values at bDMARDs initation were also higher in patients who had progress (p=0.006). There was no significant difference between the groups in the age, sex, type of bDMARDs used or other baseline laboratory data. Logistic regression analysis showed that lung involvement at the diagnosis of RA was a significiant independent risk factor for the progress (OR: 11.0, 95% CI=1.48-81.60). There was no statistically difference on progression of HRCT findings between patients received TNFi (n=22) and non-TNFi biologics (n=18), (p=1.00). The mean drug survival of first bDMARD also was not statistically different between groups (40.83±21.6 months in non-TNFi group and 42.23±40.50 months in TNFi group (p=0.90)). 5/18 (%27.8) patients in the non-TNFi group and 1/22 (%4.5) in TNFi group had died during the follow-up (p=0.14) Table 1. Demographic and clinic characteristics of the patients at the Initiation of BDMARDs. Characteristics N=40 Male/Female, n 11/29 Age at bDMARDs initiation, years (mean±SD) 56,51±10.53 Age at the diagnosis, years (mean±SD) 49,38±11,7 Disease duration at bDMARDs initiation, years (mean±SD) 7,15±5,53 Past or current smoker, n (%) 21/40 (52.5) RF positivity, n (%) 29/40 (72.5) ACPA positivity, n (%) 35/39 (89.7) Anti-SSA positivity n (%) 3/9 (33.3) Patients with Sjögren’s syndrome, n (%) 5/10 (50) ESR at bDMARDs initiation, (mm/h) 38,37 ± 22,2 CRP at bDMARDs initiation, (mg/l) 16,08 ± 14,54 DAS28 at bDMARDs initiation 3,68 ± 1,1 Respiratory symptom at bDMARDs initation, n(%) 12/40 (30) Lung involvement at the diagnosis, n (%) 8/25 (24,2) Concomitant steroid, n (%) 37/40 (92.5) Concomitant MTX, n (%) 16/40 (40) Concomitant other csDMARDs, n (%) 31/40 (%77,5) Initiated bDMARDs, TNFi/nonTNFi, n 22/18 RA-lung involvement type based on HRCT findings, n (%) -Rheumatoid nodulosis 17 (42.5) -ILD-ground-glass opacity 12 (30) -ILD-honeycombing 11 (27.5) Conclusion: This study showed that the impact of TNFi and non-TNFi biologic treatments on the course of RA-assosiated lung involvement is similar. It also suggested that lung involvement at the diagnosis of RA was a significiant risk factor for the progress of the pulmonary disease. References: [1]Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extraarticular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis. 2003;62(8):722–7 Disclosure of Interests: None declared