Progressive fibrosing interstitial lung disease in rheumatoid arthritis: A retrospective study

Background and objectiveRheumatoid arthritis associated-interstitial lung disease (RA-ILD) is the most common pulmonary manifestation of rheumatoid arthritis (RA) and an important cause of mortality. In patients suffering from interstitial lung diseases (ILD) from different etiologies (including RA-ILD), a significant proportion is exhibiting a fibrotic progression despite immunosuppressive therapies, defined as progressive fibrosing interstitial lung disease (PF-ILD). Here, we report the frequency of RA-ILD and PF-ILD in all RA patients' cohort at University Hospital of Liege and compare their characteristics and outcomes. MethodsPatients were retrospectively recruited from 2010 to 2020. PF-ILD was defined based on functional, clinical and/or iconographic progression criteria within 24 months despite specific anti-RA treatment. ResultsOut of 1,500 RA patients, about one third had high-resolution computed tomography (HRCT) performed, 89 showed RA-ILD and 48 PF-ILD. RA-ILD patients were significantly older than other RA patients (71 old of median age vs. 65, p < 0.0001), with a greater proportion of men (46.1 vs. 27.7%, p < 0.0001) and of smoking history. Non-specific interstitial pneumonia pattern was more frequent than usual interstitial pneumonia among RA-ILD (60.7 vs. 27.0%) and PF-ILD groups (60.4 vs. 31.2%). The risk of death was 2 times higher in RA-ILD patients [hazard ratio 2.03 (95% confidence interval 1.15-3.57), p < 0.01] compared to RA. ConclusionWe identified a prevalence of PF-ILD of 3% in a general RA population. The PF-ILD cohort did not seem to be different in terms of demographic characteristics and mortality compared to RA-ILD patients who did not exhibit the progressive phenotype yet.

Automated summary

Rheumatoid arthritis associated-interstitial lung disease (RA-ILD) is the most common pulmonary manifestation of rheumatoid arthritis (RA) and a significant cause of mortality. A subset of patients with RA-ILD exhibit a progressive fibrotic phenotype, known as progressive fibrosing interstitial lung disease (PF-ILD). This study retrospectively investigated the frequency of RA-ILD and PF-ILD in a cohort of RA patients, comparing their characteristics and outcomes. The results showed that RA-ILD and PF-ILD patients were older, had a higher proportion of men, and a higher prevalence of smoking history. Non-specific interstitial pneumonia pattern was more common in both RA-ILD and PF-ILD groups. The risk of death was twice as high in RA-ILD patients compared to RA patients.