Automated quantification system predicts survival in rheumatoid arthritis-associated interstitial lung disease

Area of Science:

• Rheumatology
• Pulmonology
• Radiology

Background:

• Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) has a variable clinical course, making prognosis prediction challenging.
• Accurate prognostic markers are crucial for managing RA-ILD patients.

Purpose of the Study:

• To evaluate the prognostic value of an automated quantification system (AQS) in predicting outcomes for RA-ILD patients.
• To assess if quantitative lung fibrosis (QLF) scores can identify patients with poor prognoses.

Main Methods:

• Retrospective analysis of clinical data and high-resolution CT (HRCT) images from 144 RA-ILD patients.
• Measurement of quantitative lung fibrosis (QLF) and interstitial lung disease (QILD) scores using an AQS.
• Multivariable Cox and receiver-operating characteristic (ROC) curve analyses to identify prognostic factors and assess predictive performance.

Main Results:

• Higher QLF, QHC, and QILD scores, along with older age and higher ESR, were independent predictors of mortality in RA-ILD.
• QLF scores demonstrated strong predictive performance for 5-year mortality, comparable to QILD scores.
• Patients with high QLF scores (≥12% lung volume) had significantly higher 5-year mortality (50%) compared to those with low QLF scores (17.4%).

Conclusions:

• Quantitative lung fibrosis (QLF) scores derived from AQS are valuable for predicting prognosis in RA-ILD.
• High QLF scores identify a distinct poor prognostic phenotype in RA-ILD, mirroring outcomes seen in idiopathic pulmonary fibrosis (IPF).