POS0211 PREDICTORS OF PROGRESSION AND MORTALITY IN PATIENTS WITH PREVALENT RHEUMATOID ARTHRITIS AND INTERSTITIAL LUNG DISEASE: A PROSPECTIVE COHORT STUDY
Authors: N. Mena-Vázquez, M. Rojas-Giménez, C. M. Romero-Barco, S. Manrique Arija, F. Espildora, M. C. Aguilar-Hurtado, R. Ortega Castro, I. Añón Oñate, L. Pérez Albaladejo, F. Godoy-Navarrete, I. Ureña, M. Velloso Feijoo, R. Redondo, F. G. Jiménez-Núñez, B. Panero Lamothe, M. I. Padin-Martín, A. Fernandez-Nebro
Journal: Annals of the Rheumatic Diseases (2021)

Objectives: To analyze the effect of disease-modifying antirheumatic drugs (DMARDs) and identify risk factors associated with disease progression and mortality in patients with rheumatoid arthritis associated with interstitial lung disease (RA-ILD). Methods: We performed a multicenter, prospective, observational study of patients with RA-ILD receiving DMARDs between 2015 and 2020. The patients were assessed using high-resolution computed tomography and pulmonary function tests at baseline and at 60 months. The main outcome measure at 60 months was worsening of FVC &gt;10% or DLCO &gt;15% and radiological progression or death. We recorded demographic and clinical characteristics, lung function, and the incidence of adverse events. A Cox regression analysis was performed to identify factors associated with worsening of ILD. Results: After 60 months, lung disease had stabilized in 66 patients (56.9%), improved in 9 (7.8%), and worsened in 23 (19.8%). Eighteen patients (15.5%) died, with a mean survival of 71.8 (1.9) months. Baseline characteristics of 116 with RA-ILD treated with DMARDs is in table 1.The Cox multivariate analysis revealed the independent predictors of worsening of RA-ILD to be usual interstitial pneumonia (HR, 2.6 [95%CI, 1.0-6.7]), forced vital capacity (%) (HR, 3.8 [95%CI, 1.5-6.7]), anticitrullinated protein antibody titers (HR, 2.8 [95%CI, 1.1-6.8]), smoking (HR, 2.5 [95%CI, 1.1-6.2]), and treatment with abatacept, tocilizumab, or rituximab (HR, 0.4 [95%CI, 0.2-0.8]). During follow-up, 79 patients (68%) experienced an adverse event, mostly infection (61%). Conclusion: Lung function is stable in most patients with RA-ILD receiving treatment with DMARDs, although one third of patients die. Identifying factors of worsening in RA-ILD is important for clinical management. Table 1. Baseline characteristics of 116 with RA-ILD treated with DMARDs Variable Total=116 Epidemiological characteristics Female sex, n (%) 63 (54.3) Age, years, mean (SD) 68.3 (9.9) Clinical and analytical characteristics Current smoker Nonsmoker, n (%) 57 (49.1) Smoker, n (%) 23 (19.8) Exsmoker, n (%) 36 (31.0) Time since diagnosis of RA, months, median (p25-p75) 148.5 (71.5-217.8) Diagnostic delay, months, median (p25-p75) 8.5 (4.9-16.8) Time since diagnosis of ILD, months, median (p25-p75) 27.5 (9.8-60.0) Positive rheumatoid factor (&gt;10), n (%) 111 (95.7) Positive ACPA titer (&gt;20), n (%) 100 (86.2) Erosive disease, n (%) 76 (65.5) Treatment Synthetic DMARD 100 (86.2) Methotrexate, n (%) 51 (44.0) Leflunomide, n (%) 30 (25.9) Sulfasalazine, n (%) 9 (7.8) Hydroxychloroquine, n (%) 21 (18.1) Biologic DMARD 50 (43.1) Infliximab, n (%) 1 (0.9) Etanercept, n (%) 6 (5.2) Adalimumab, n (%) 3 (2.6) Golimumab, n (%) 3 (2.6) Certolizumab, n (%) 3 (2.6) Tocilizumab, n (%) 6 (5.2) Abatacept, n (%) 15 (12.9) Rituximab, n (%) 13 (11.2) Immunosuppressants 11 (9.5) Mycophenolate, n (%) 7 (6.0) Azathioprine, n (%) 4 (3.4) Antifibrotic agents, nintedanib, n (%) 1 (0.9) Baseline corticosteroids, n (%) 69 (60.0) Dose of baseline corticosteroids, median (p25-p75) 5.0 (0.0-7.5) Abbreviations. RA: rheumatoid arthritis; ILD: interstitial lung disease; ACPA: anticyclic citrullinated protein antibody; DMARD: disease-modifying antirheumatic drug; SD: standard deviation. Acknowledgements: Grant for Medical Researchers of the “Fundación Española de Reumatología” 2019. declare. Disclosure of Interests: None declared