POS0603 RADIOGRAPHIC DETERIORATION OF AIRWAY DISEASE IS ASSOCIATED WITH MORTALITY IN RHEUMATOID ARTHRITIS
Authors: M. Yoshida, T. Zoshima, I. Mizushima, Y. Iwata, M. Kawano
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> In rheumatoid arthritis (RA), lung involvement includes interstitial lung disease (ILD) and airway disease (AD). While these have been reported to be associated with mortality, the impact of AD deterioration on prognosis remains unclear. <h3>Objectives:</h3> To investigate the relationship between radiographic deterioration of AD in RA and mortality. <h3>Methods:</h3> We retrospectively examined 720 RA patients who visited our department between 2011 and 2021. Among these, we enrolled patients who underwent chest computed tomography (CT) scans at least twice. The baseline was defined as the time of the initial chest CT scan, and the final observation as the final visit or death. CT findings were evaluated by two experienced radiologists. Patients whose RA-related lung involvement could not be fully evaluated from chest CT scans due to other causes were excluded. Radiographic definitions of AD and ILD followed the previous report (Ref. 1). The severity of AD was evaluated semi-quantitatively using radiographic grades ranging from 0 to 4. AD deterioration was defined as an increase in radiographic grade in grade 0–3 or an expansion of lesion areas in grade 4. Among patients complicated AD, we compared patients in the AD deterioration group with those in the non-AD deterioration group. In a multivariate Cox regression analysis, we identified factors associated with mortality by adjusting for age, sex, RA treatment, comorbidities including diabetes, deterioration of AD, and the presence of ILD and AD. <h3>Results:</h3> Among the 353 patients with repeated scans (mean age, 60.9 years.; female, 73.7%; mean observation period, 186.6 months), 126 had AD (35.7%), 102 had ILD (28.9%) at the baseline. In the subset of RA patients with complicated AD (126 cases), baseline characteristics (age, sex, RA disease activity, RF/ACPA positivity, RA treatment, presence of ILD, AD grade, comorbidities including diabetes, and observation period) were similar between the AD deterioration group (25 cases, 19.8%) and the non-AD deterioration group. However, mortality was significantly higher in the AD deterioration group (16.0% vs. 4.0%, <i>p</i>=0.049). Kaplan-Meier analysis with log-rank tests confirmed significantly higher mortality in the AD deterioration group (<i>p</i>=0.005). Cox regression analysis revealed that AD deterioration was a significant independent risk factor for mortality (HR 6.029, 95% CI 1.400–25.970). Moreover, in all cases with repeated CT scans (353 cases), Cox regression analysis also revealed that AD deterioration was an independent risk factor for mortality (HR 3.596, 95% CI 1.166–11.097). <h3>Conclusion:</h3> In RA patients, the deterioration of AD is an independent risk factor for mortality. Consequently, longitudinal pulmonary radiographic examinations are essential for those with RA complicated by AD. <h3>REFERENCES:</h3> [1] Radiology 2004;232:81–91. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>