SAT0128 The risk factors for severe exacerbation of interstitial lung disease in rheumatoid arthritis during bdmard therapy
Authors: A. Tanaka, K. Kurasawa, T. Miyao, Y. Takamura, R. Yamazaki, S. Arai, T. Owada, R. Maezawa, M. Arima
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Rheumatoid arthritis (RA) is a systemic inflammatory disease that affects joints and various organs. The lung is one of the most common site of extra-articular involvement. Interstitial lung disease (ILD) is one form of the lung involvement and influences prognosis of the patients. RA-ILD frequently developed acute exacerbation. Once acute exacerbation occurs, the prognosis of patients is poor. However, it is not fully elucidated what the risk factors for severe exacerbation of ILD are. <h3>Objectives</h3> The purpose of thisstudy was to identify the risk factors for severe exacerbation of ILD in RApatients during bDMARDs therapy.The purpose of this study was to identify therisk factors for exacerbation of ILD in RA patients under the bDMARDs therapy. <h3>Methods</h3> A retrospective cohort study. Subjects were consecutive 208 RA patients who were treated with bDMARDs from 2004 to 2015 in our department and received HRCT scan before and during the therapy. Based on HR-CT imaging, pulmonary abnormalities were classified into 4 categories (ILD, nodular lesions, airway disease (AD) and others) and 20 lesions such as ground-glass opacity (GGO), reticular pattern, bronchiolitis and bronchiectasis. We recorded their existence and distribution before andduring the therapy and examined their changes. Severe exacerbation of ILD was judged when patients revealed newly emerging/worsening of ILD lesions regardless of pre-existing pulmonary lesions and deceased or had to stop bDMARDs due to exacerbation of ILD. To identify risk factors, logistic regression analysis was conducted. <h3>Results</h3> Subjects were 208 RApatients, M/F; 64/144, mean age; 59.2 years old, disease duration; 7.9 years positive for RF in 84.1%. bDMARDs used for the longest period were TNFinhibitors in 79.8% of the subjects, abatacept in 15.4% and tocilizmab in 4.8%. Pulmonary abnormalities were found in 146 (70.2%) of RA patients before bDMARDs (ILD 81,(38.9%); nodular lesions 45, (21.6%); and ADs, 115, (55.3%)). GGO, consolidation, reticular pattern and honey combing was found in 14.8%, 19.8%, 51.9%, and 17.3% of ILD patients. Most of ILD lesions coexisted with ADs. During the observation period (3.26±2.61 years), newly emerging/worsening pulmonary lesions were found in 42.3% of patients and the incidence of which was 13.7/100person year. The incidence of newly development and worsening of ILD were 7.0/100 person years and 1.5/100 person years, respectively. Severe exacerbation of ILD was developed in 13 patients (6.3%) and the incidence of which was 2.0/100 person year. Of 13 patients, 9 died of respiratory failure. All patients with severe exacerbation revealed GGO/consolidation.Interestingly, all these active ILD lesions were newly emerging lesions, however, most of the patients had pre-existing pulmonary lesions. We identified risk factors for severe exacerbation of ILD (Table1). The risk factors for severe exacerbation of ILD were older age and pre-existing pulmonary lesions of ILD and of ADs, particularly reticular pattern, honeycomb and bronchiectasis. Sero-positivity and choice of biologics were not identified as risk factors. <h3>Conclusions</h3> The incidence of severe exacerbation of ILD was 2.0/100 person years. The risk factors forsevere exacerbation of ILD were older age and pre-existing reticular pattern,honeycomb and bronchiectasis. <h3>Disclosure of Interest:</h3> None declared