Interstitial lung disease has a poor prognosis in rheumatoid arthritis: results from an inception cohort.
OBJECTIVE
Pulmonary complications of RA are well described. Although some are benign, interstitial lung disease (ILD) has a poor prognosis. Few RA inception cohorts have reported the natural history of ILD related to RA (RA-ILD). We examine its incidence, outcome and prognostic indicators.


METHODS
Extra-articular features and comorbidity have been recorded yearly in a well-established inception cohort of RA with a 20-year follow-up. Standard clinical, laboratory and radiological measures of RA were recorded at baseline and yearly. Details of deaths were provided by a national central register.


RESULTS
Out of 1460 patients, 52 developed RA-ILD, half either at baseline or within 3 years of onset. The annualized incidence was 4.1/1000 (95% CI 3.0, 5.4) and the 15-year cumulative incidence 62.9/1000 (95% CI 43.0, 91.7). Incidence of RA-ILD was associated with older age, raised baseline ESR and HAQ. Evidence to implicate any drug effect (e.g. MTX) was lacking. Of these patients, 39 died, attributed to RA-ILD in 28. Median survival following diagnosis of RA-ILD was 3 years.


CONCLUSIONS
RA-ILD is an important and early feature of RA. It is related to disease activity and has a poor prognosis. Further studies are required to determine whether screening for pulmonary disease would identify these patients at an earlier stage.
Koduri
Gouri
G
ERAS, Rheumatology Department, St Albans City Hospital, Waverley Road, St Albans AL3 5PN, UK.
Norton
Sam
S
Young
Adam
A
Cox
Nigel
N
Davies
Paul
P
Devlin
Joe
J
Dixey
Josh
J
Gough
Andrew
A
Prouse
Peter
P
Winfield
John
J
Williams
Peter
P
D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D015331:Cohort Studies; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
D018501:Antirheumatic Agents