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Background: Rheumatoid Arthritis (RA) is characterized by persistent joint synovitis causing progressive destruction of the cartilage and bone. Interstitial lung disease (ILD) is a frequent extra-articular manifestation of RA. Clinical profiles of patients with RA-associated ILD may vary.
Objectives: To describe the clinical characteristics and radiological patterns and evaluate the different clinical profile between two different cohorts of patients (pts) with RA- associated ILD.
Methods: Retrospective cohort study. We collected clinical and epidemiological data of pts seen in outpatient clinic from a Hospital from Barcelona, Spain and another from Jacksonville, Florida, USA. Pts who met the RA ACR/EULAR 2010 criteria and the ILD American Thoracic Society /European Respiratory Society 2013 classification criteria were selected. The study was approved by both local committees.
Results: A total of 63 pts were included, 37 from Barcelona and 26 from Jacksonville. Forty-one pts (65%) were women with a median age of 68 years. General characteristics are summarized in Table. Thirty-eight pts (60.3%) were former smokers, but only 9 pts (14.3%) were current smokers. Fifty-two pts (82.5%) were Caucasian, 9.5% Mestizo, 3.2% Maghreb and 1.6% Indian. Most were overweight with mean BMI of 28.6 (SD 5.4). The Barcelona cohort showed more erosive disease than the pts from Jacksonville (26 vs 5 pts, p= 0.00). Seven pts had ILD diagnosis before RA. 4.82 (range 0-33) years was the median evolution from RA diagnosis until ILD diagnosis. Most common type of ILD was usual interstitial pneumonia (UIP) in 40% of pts, followed by nonspecific interstitial pneumonia (NSIP) in 25% of pts. Respiratory bronchiolitis was significantly more common in Barcelona cohort, while unspecific pattern in Jacksonville cohort (Table). A total of 71.4% were under GC treatment, methotrexate was used in 23 pts (36.5%), leflunomide in 14 (22.2%) and hydroxychloroquine in 7 pts (11.1%) prior to diagnosis of ILD. 6 out of 26 pts from Jacksonville were under MMF. TNF-α inhibitors were the most commonly used bDMARD in both cohorts as a first-line option prior to ILD diagnosis. Currently, half of the patients (50.8%) were under bDMARD. Current use of bDMARD was more often in US cohort (80.7%) than in Barcelona cohort (29.7%). Rituximab (RTX) was the most common bDMARD currently used (17 pts). Jacksonville pts were more commonly treated with RTX, while Barcelona pts were more commonly treated with Abatacept.
Conclusion: Globally pts with RA-associated ILD have similar clinical profile in both centers, however, we found some differences in radiological patterns and treatment strategies between both cohorts. Those differences could be explained in part by sociodemographic differences, diagnostic and therapeutic approach and/or access for health care among others.
| Total
| Barcelona cohort
| Jacksonville
| P value | |
|---|---|---|---|---|
| Caucasian, patients (%) | 52 (82.5%) | 31 (83.8) | 21 (77.8) | 0,49 |
| Time RA evolution, mean years (SD) | 10.58 (8.01) | 11.63 (7) | 9 (9.24) | 0.80 |
| Time ILD evolution, mean years (SD) | 3.89 (3.20) | 3.86
| 4 (3.12) | 0.28 |
| Erosive disease, patients (%) | 31 (49.2) | 26 (72,2) | 5 (18.5) | 0,00 |
| Rheumatoid nodules, patients (%) | 8 (12,7) | 7 (18,9) | 1 (3.8) | 0,12 |
| Current scDMARDs treatment, patients (%) | 35 (55.55) | 31 (49.20) | 4 (6.34) | 0,002 |
| Current bDMARD treatment, patients (%) | 32 (50.8%) | 11 (17.5) | 21 (33.3) | 0,001 |
| ILD type | ||||
| Usual interstitial pneumonia (UIP), patients (%) | 25 (40.3) | 14 (37.8) | 11 (44) | 0,08 |
| Nonspecific interstitial pneumonia (NSIP), patients (%) | 16 (25.8) | 14 (37.8) | 2 (8) | 0,23 |
| Respiratory bronchiolitis–interstitial lung disease (RB), patients (%) | 7 (11.3) | 7 (18.9) | 0 | 0,039 |
| Cryptogenic organizing pneumonia (OP), patients (%) | 4 (6.5) | 2 (5.4) | 2 (8) | 0,43 |
| Unspecific, patients (%) | 8 (12.9) | 0 | 8 (32) | 0,004 |
Disclosure of Interests: Ana Belén Azuaga-Piñango: None declared, Yan Li: None declared, Raul Castellanos-Moreira Speakers bureau: Lilly, MSD, Sanofi, UCB, Virginia Ruiz Speakers bureau: Lilly, Pfizer, Raimón Sanmartí Speakers bureau: Abbvie, Eli Lilly, BMS, Roche and Pfizer, Isabel Mira-Avendano: None declared, Andy Abril: None declared, Jose A. Gómez-Puerta Speakers bureau: Abbvie, BMS, GSK, Lilly, Pfizer, Roche