Characterizing Race-Based Differences in Antisynthetase Syndrome Interstitial Lung Disease

Background: Interstitial lung disease (ILD) is the most serious manifestation of antisynthetase syndrome (ASyS). Limited research has explored racial differences in the clinical presentation and outcomes of ASyS-ILD. This study compared clinical manifestations, pulmonary function, and outcomes between Black and White patients with ASyS-ILD. Methods: A retrospective analysis was conducted using electronic health records from 2010 to 2020. Patients diagnosed with ILD and positive antisynthetase antibodies were included (N = 66; 34 Black and 32 White). Demographics, comorbidities, clinical features, pulmonary function tests, chest imaging, and clinical outcomes were compared between races. Results: Black patients were younger at diagnosis (49.1 ± 10.8 vs. 55.1 ± 12.9 years, p = 0.043) and had reduced pulmonary function (p < 0.01). Black patients also had a higher prevalence of traction bronchiectasis (96.6% vs. 73.1%, p = 0.012) and obstructive sleep apnea (p = 0.025). There were no differences in the frequency of hospitalizations, intensive care unit admissions, or deaths between groups. Myositis was common in both groups, and the distribution of antisynthetase antibodies did not differ by race (p = 0.333). Conclusions: Black patients are younger at diagnosis, have reduced lung function, and have increased traction bronchiectasis compared to White patients with ASyS-ILD. There is a higher prevalence of obstructive sleep apnea amongst Black patients without differences in body mass index. There was no difference in mortality and the need for lung transplantation. This study highlights several key differences between Black and White patients with ASyS-ILD. Longitudinal prospective studies are crucial to rigorously investigate race-based differences in morbidity, mortality, and long-term outcomes among patients with ASyS-ILD.