Rheumatoid Arthritis-Related Lung Disease and Its Association With Mortality

Area of Science:

• Rheumatology
• Pulmonology
• Medical Imaging

Background:

• Rheumatoid arthritis (RA) is a systemic autoimmune disease with significant extra-articular manifestations.
• Rheumatoid arthritis-related lung disease (RA-LD) encompasses various pulmonary complications, impacting patient prognosis.
• Understanding the specific subtypes of RA-LD and their association with mortality is crucial for clinical management.

Purpose of the Study:

• To investigate the association between rheumatoid arthritis-related lung disease (RA-LD) and its subtypes with all-cause mortality.
• To identify which RA-LD subtypes contribute most significantly to increased mortality risk in RA patients.

Main Methods:

• Analysis of chest computed tomography (CT) scans in 576 rheumatoid arthritis (RA) patients.
• Classification of RA-LD into four subtypes: interstitial lung disease (RA-ILD), airway disease (RA-AD), rheumatoid pulmonary nodules (RA-PN), and RA-related pleural disease (RA-PD).
• Multivariable logistic regression analyses were employed to assess factors associated with all-cause mortality following a median follow-up of 10.2 years.

Main Results:

• Rheumatoid arthritis-related lung disease (RA-LD) was diagnosed in 43.9% of RA patients.
• Rheumatoid arthritis-related airway disease (RA-AD) was the most frequent subtype (47.0%), followed by RA-ILD (42.3%).
• The presence of any RA-LD subtype (OR=1.60) and two or more subtypes (OR=2.39) significantly increased all-cause mortality. RA-ILD (OR=2.20) and RA-PD (OR=1.62) were associated with increased mortality.

Conclusions:

• Rheumatoid arthritis-related lung disease (RA-LD) is common in RA patients and is associated with increased all-cause mortality.
• The risk of mortality is particularly elevated in patients with multiple RA-LD subtypes, as well as those with RA-ILD and RA-PD.
• Early identification and management of RA-LD subtypes are essential for improving survival in rheumatoid arthritis patients.