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.
ERAS, Rheumatology Department, St Albans City Hospital, Waverley Road, St Albans AL3 5PN, UK.
Gouri
G
Koduri
Sam
S
Norton
Adam
A
Young
Nigel
N
Cox
Paul
P
Davies
Joe
J
Devlin
Josh
J
Dixey
Andrew
A
Gough
Peter
P
Prouse
John
J
Winfield
Peter
P
Williams
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