POS0211\u2005PREDICTORS OF PROGRESSION AND MORTALITY IN PATIENTS WITH PREVALENT RHEUMATOID ARTHRITIS AND INTERSTITIAL LUNG DISEASE: A PROSPECTIVE COHORT STUDY

Abstract

To analyze the effect of disease-modifying antirheumatic drugs (DMARDs) and identify risk factors associated with disease progression and mortality in patients with rheumatoid arthritis associated with interstitial lung disease (RA-ILD).We performed a multicenter, prospective, observational study of patients with RA-ILD receiving DMARDs between 2015 and 2020. The patients were assessed using high-resolution computed tomography and pulmonary function tests at baseline and at 60 months. The main outcome measure at 60 months was worsening of FVC >10% or DLCO >15% and radiological progression or death. We recorded demographic and clinical characteristics, lung function, and the incidence of adverse events. A Cox regression analysis was performed to identify factors associated with worsening of ILD.After 60 months, lung disease had stabilized in 66 patients (56.9%), improved in 9 (7.8%), and worsened in 23 (19.8%). Eighteen patients (15.5%) died, with a mean survival of 71.8 (1.9) months. Baseline characteristics of 116 with RA-ILD treated with DMARDs is in table 1.The Cox multivariate analysis revealed the independent predictors of worsening of RA-ILD to be usual interstitial pneumonia (HR, 2.6 [95%CI, 1.0-6.7]), forced vital capacity (%) (HR, 3.8 [95%CI, 1.5-6.7]), anticitrullinated protein antibody titers (HR, 2.8 [95%CI, 1.1-6.8]), smoking (HR, 2.5 [95%CI, 1.1-6.2]), and treatment with abatacept, tocilizumab, or rituximab (HR, 0.4 [95%CI, 0.2-0.8]). During follow-up, 79 patients (68%) experienced an adverse event, mostly infection (61%).Lung function is stable in most patients with RA-ILD receiving treatment with DMARDs, although one third of patients die. Identifying factors of worsening in RA-ILD is important for clinical management.Table 1.Baseline characteristics of 116 with RA-ILD treated with DMARDsVariableTotal=116Epidemiological characteristicsFemale sex, n (%)63 (54.3)Age, years, mean (SD)68.3 (9.9)Clinical and analytical characteristicsCurrent smokerNonsmoker, n (%)57 (49.1)Smoker, n (%)23 (19.8)Exsmoker, n (%)36 (31.0)Time since diagnosis of RA, months, median (p25-p75)148.5 (71.5-217.8)Diagnostic delay, months, median (p25-p75)8.5 (4.9-16.8)Time since diagnosis of ILD, months, median (p25-p75)27.5 (9.8-60.0)Positive rheumatoid factor (>10), n (%)111 (95.7)Positive ACPA titer (>20), n (%)100 (86.2)Erosive disease, n (%)76 (65.5)Treatment Synthetic DMARD100 (86.2)\u2003Methotrexate, n (%)51 (44.0)\u2003Leflunomide, n (%)30 (25.9)\u2003Sulfasalazine, n (%)9 (7.8)\u2003Hydroxychloroquine, n (%)21 (18.1)Biologic DMARD50 (43.1)\u2003Infliximab, n (%)1 (0.9)\u2003Etanercept, n (%)6 (5.2)\u2003Adalimumab, n (%)3 (2.6)\u2003Golimumab, n (%)3 (2.6)\u2003Certolizumab, n (%)3 (2.6)\u2003Tocilizumab, n (%)6 (5.2)\u2003Abatacept, n (%)15 (12.9)\u2003Rituximab, n (%)13 (11.2)\u2003Immunosuppressants11 (9.5)\u2003Mycophenolate, n (%)7 (6.0)\u2003Azathioprine, n (%)4 (3.4)\u2003Antifibrotic agents, nintedanib, n (%)1 (0.9)\u2003Baseline corticosteroids, n (%)69 (60.0)\u2003Dose of baseline corticosteroids, median (p25-p75)5.0 (0.0-7.5)Abbreviations. RA: rheumatoid arthritis; ILD: interstitial lung disease; ACPA: anticyclic citrullinated protein antibody; DMARD: disease-modifying antirheumatic drug; SD: standard deviation.Grant for Medical Researchers of the “Fundación Española de Reumatología” 2019. declare.None declared