期刊
JOURNAL OF RHEUMATOLOGY
卷 48, 期 5, 页码 656-663出版社
J RHEUMATOL PUBL CO
DOI: 10.3899/jrheum.200863
关键词
interstitial lung disease; obesity; respiratory diseases; rheumatoid arthritis
类别
资金
- Rheumatology Research Foundation K Supplement Award
- National Institutes of Health (NIH) [K23 AR069688, K23 HL119558, R03 AR075886, R03 HL148484, L30 AR066953, P30 AR070253, P30 AR072577]
- Sanofi
- Bristol-Myers Squibb
- Crescendo Bioscience
- R. Bruce and Joan M. Mickey Research Scholar Fund
This study identified obesity, high CRP levels, poor functional status, and extensive smoking as novel risk factors for RA-ILD, which may be helpful for RA-ILD risk assessment and prevention. The overall predictive ability for RA-ILD remains modest.
Objective. To determine the association between novel lifestyle factors on risk of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD), define the threshold at which smoking increases RA-ILD risk, and calculate the degree to which known lifestyle and clinical factors predict RA-ILD. Methods. This nested case-control study matched incident RA-ILD cases to RA non-ILD controls on age, sex, RA duration, rheumatoid factor, and time from exposure assessment to RA-ILD. Exposures included education, BMI, smoking, anticyclic citrullinated peptide antibodies, race, joint erosions, rheumatoid nodules, C-reactive protein (CRP), disease activity score, functional status, disease-modifying anti rheumatic drug use, and glucocorticoid use. OR for each exposure on risk of RA-ILD were obtained from logistic regression models. Area under the curve (AUC) was calculated based on all lifestyle and clinical exposures. Results. We identified 84 incident RA-ILD cases and 233 matched controls. After adjustment, obesity, high-positive CRP (>= 10 mg/L), and poor functional status (multidimensional Health Assessment Questionnaire [MDHAQ] >= 1) were associated with increased risk of RA-ILD (OR 2.42, 95% CI 1.11-5.24 vs normal BMI; OR 2.61, 95% CI 1.21-5.64 vs CRP < 3 mg/L; OR 3.10, 95% CI 1.32-7.26 vs MDHAQ < 0.2). Smoking 30 pack-years or more was strongly associated with risk of RA-ILD compared to never smokers (OR 6.06, 95% CI 2.72-13.5). Together, lifestyle and dinical risk factors for RA-ILD had an AUC of 0.79 (95% CI 0.73-0.85). Conclusion. Obesity, CRP, functional status, and extensive smoking may be novel risk factors for RA-ILD that may be useful for RA-ILD risk assessment and prevention. The overall ability to predict RA-ILD remains modest.
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