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THU0106 Identification of Markers Associated with The Occurrence of Interstitial Lung Disease in Rheumatoid Arthritis Patients
  1. P.-A. Juge1,
  2. L. Wemeau2,
  3. S. Marchand-Adam3,
  4. M.-P. Debray1,
  5. H. Nunes4,
  6. S. Gazal1,
  7. S. Ottaviani1,
  8. T. Schaeverbeke5,
  9. N. Saindenberg4,
  10. D. Valeyre4,
  11. G. Thabut1,
  12. M.-C. Boissier6,
  13. L. Dunogeant7,
  14. Y. Allanore8,
  15. C. Richez5,
  16. R.-M. Flipo2,
  17. B. Wallaert2,
  18. P. Richette9,
  19. V. Cottin10,
  20. J. Sibilia11,
  21. R. Borie1,
  22. B. Coustet1,
  23. H. Liote12,
  24. M. Soubrier13,
  25. A. Frazier9,
  26. B. Crestani1,
  27. P. Dieude1
  1. 1CHU Bichat, Paris
  2. 2CHU de Lille, Lille
  3. 3CHU de Tours, Tours
  4. 4CHU Avicennes, Bobigny
  5. 5CHU de Bordeaux
  6. 6CHU Avicennes, Bordeaux
  7. 7CH Aix en Provence, Aix-en-Provence
  8. 8CHU Cochin
  9. 9CHU Lariboisière, Paris
  10. 10CHU de Lyon, Lyon
  11. 11CHU Strasbourg, Strasbourg
  12. 12CHU Tenon, Paris
  13. 13CHU de Clermont Ferrand, Clermond Ferrand, France

Abstract

Background Rheumatoid arthritis (RA) is a systemic autoimmune disease, the most severe manifestation being interstitial lung disease (ILD). Therapeutic options are undefined and ILD is one of the leading causes of mortality for RA patients. A better characterization of RA-ILD–associated factors may improve the risk stratification of RA patients.

Objectives To identify variables associated with ILD occurrence in RA.

Methods RA-ILD patients (RA-ILD+) in a French multicentric cohort were compared to monocentric RA cases without ILD (RA-ILD-). All patients fulfilled 2010 ACR/EULAR criteria for RA and had a HRCT chest scan for suspected ILD or during a pre-biologic assessment. ILD was defined by HRCT results. Because ILD occurrence increases with RA duration, RA-ILD+ and RA-ILD- patients were matched by disease duration (1:1). Demographic data, clinical features of RA and treatment modalities before the ILD diagnosis were collected. Results significant on univariate analysis (P<0.15) were selected for multivariate analysis to identify variables independently associated with RA-ILD. Duration of methotrexate (MTX) and anti-TNF agent use was adjusted to mean MTX or anti-TNF duration before ILD diagnosis.

Results Among 253 consecutive RA patients, 81 were male (32.02%), 112 (48.07%) were smokers, mean age at RA onset was 48.11 ± 16.33 years, and mean RA duration 11.69 ± 10.10 years; 199 patients (85.78%) were ACPA-positive and 171 (71.85%) had erosive status; 134 (60.63%) received MTX and 63 (28.25%) a TNF inhibitor. Among the 253 patients, 138 (54.55%) had ILD. Among the RA-ILD+ patients, 72 (74.23%) had UIP and 25 (25.77%) NSIP. On univariate analysis, ILD was associated with older age at RA onset (52.69 ± 15.00 vs 42.86 ± 16.26 years, P=0.0001), male sex (40.68% vs 21.74%, P=0.001), ACPA rate ≥60 N (20.63% vs 6.41%, P=0.012), less use of anti-TNF agents and MTX (14.55% vs 41.59%, P=0.001, and 50.94% vs 69.57, P=0.005, respectively) and lower MTX dosage (15.26 ± 4.44 vs 16.83 ± 4.31 mg/week, P=0.046). There was no difference for erosive status. On multivariate analysis, ILD was independently associated with older age at RA onset (P<0.0001), male sex (P=0.0006), less use of MTX (P=0.015) with lower dosage (P=0.005) and less use of anti-TNF agents (P=0.004).

Conclusions As previously reported, ILD was independently associated with male sex as well as older age at RA onset and, of interest, less use of MTX and anti-TNF biologics before ILD diagnosis, even though patients did not differ in erosive status. Larger prospective studies are required to further elucidate the role of DMARDs and anti-TNF biologics in ILD occurrence and progression in RA patients.

Disclosure of Interest None declared

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