Background: Pulmonary involvement is the most common extra-articular Rheumatoid Arthritis (RA) manifestation. Interstitial lung disease is an important and early feature and can increase the mortality risk in RA patients. In Morocco no previous studies have been carried out to identify the prevalence of lung disease in RA patients nor have the risk factors for development of interstiel lung disease (ILD).
Objectives: The aim of this study was to investigate the prevalence of lung disease and analyse the ILD associated risk factors, in Moroccan patients with rheumatoid arthritis.
Methods: This was a retrospective analysis of 288 patients diagnosed with RA between January 2014 and December 2019. Exclusion criteria were: pregnant women, history of other autoimmune disease than RA, pulmonary tuberculosis diagnostignosed before lung exploration, any drugs known to cause pulmonary changes (such as Amiodarone). Clinical, and laboratory features were recorded simultaneously with the period of pulmonary exploration. Lung involvement was assessed by High-resolution computed Tomography (HRCT). Statistical analyses were performed using SPSS 20.0. The t-test was employed to compare means of continuous variables, whereas chi-square test was used to compare frequencies. Variables that were significantly associated with ILD using univariate analyses, were included in multivariate logistic regression model. Statistical significance was considered if p<0.05.
Results: The majority (89.2%) of patients were female. Mean age was 52.6±12.53 years and disease duration was 11.2±9.3 years. A total of 48 (16.7%) patients were noted to have respiratory symptomatology. Lung involvement was documented in 189 (65.6%) patients. In each compartment of the lung, abnormal HRCT findings suggestive of ILD were detected in 134 (70.8%) cases, bronchiectasis in 37 (19.5%) and then pleural effusion in 11 (5.8%) (Table 1).
In multivariate analysis, ILD was associated with male older age (OR=1.43, 95% IC [1.202-1.952], p=0.037), advanced age at RA onset (OR=2.17, 95% IC [1.151-1.874], p=0.007), extra-articular manifestations (OR=10.8, 95% IC [5.312-12.300], p<0.001), disease activity (OR=2.68, 95% IC [1.463-1.715], p<0.001) and low methotrexate dose (OR=1.03, 95% IC [1.003-1.106], p=0.031).
Conclusion: ILD was the most prevalent manifestation of RA lung involvement, it was associated to male gender, older age active and severe RA.
References: Paolo Spagnolo et al. The lung in rheumatoid arthritis. Focus on interstitial lung Disease. Arthritis and Rheumatology. 2018-5, 1-11. Doi: 10.1002/art.40574.
Ana C. Duate et al. The lung in a cohort of rheumatoid arthritis patients-an overview of different types of involvement ant treatment. Oxford University Press. British Society for Rheumatology.2019-4. Doi:10.1093/rheumatology/kez177.
Disclosure of Interests: None declared
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