title: Survival and quality of life in rheumatoid arthritis-associated interstitial lung disease after lung transplantation.
abstract: BACKGROUND
  Patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) have increased mortality with limited treatment options. We set out to examine post-transplant survival in RA-ILD patients compared with patients with idiopathic pulmonary fibrosis (IPF) and scleroderma-associated ILD (SSc-ILD). We also describe post-transplant quality of life (QoL) outcomes in RA-ILD.
  
  
  METHODS
  A retrospective review was performed on lung transplantation (1989 to 2011) among patients with RA-ILD, IPF (group-matched for age and transplant year) and SSc-ILD. Cumulative survival after transplantation was estimated by the Kaplan-Meier method and compared between groups using the log-rank test. The 36-item Medical Outcomes Survey Short Form (SF-36) and the St. George's Respiratory Questionnaire (SGRQ) scores, before and after lung transplantation, were analyzed.
  
  
  RESULTS
  Overall, 10 patients with RA-ILD, 53 with IPF and 17 with SSc-ILD underwent lung transplantation with ages (mean ± SD) of 59.4 ± 5.6, 61.0 ± 4.0 and 45.4 ± 12.7 years, respectively. Cumulative survival rates at 1-year post-transplant for the RA-ILD, IPF and SSc-ILD groups were 67%, 69% and 82%, respectively, and there was no significant difference among groups in age- and gender-adjusted analyses. Among the RA-ILD patients, mean SF-36 physical component summary scores improved from 22.4 ± 8.1 to 32.2 ± 12.9 (p = 0.1), SF-36 mental component summary scores improved from 44.7 ± 15.3 to 54.9 ± 4.8 (p = 0.19) and SGRQ total scores improved from 70.4 ± 16.1 to 36.0 ± 18.5 (p = 0.03).
  
  
  CONCLUSIONS
  After lung transplantation, RA-ILD and IPF patients have similar survival rates. Further, in RA-ILD patients, lung transplantation appears to result in a significant improvement in QoL with regard to respiratory symptoms. These data suggest that lung transplantation should be considered in patients with end-stage RA-ILD.
authors.affiliation: Divisions of Rheumatology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Arash
authors.initials: A
authors.lastname: Yazdani
authors.affiliation: Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lianne G
authors.initials: LG
authors.lastname: Singer
authors.affiliation: Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Strand
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Allan C
authors.initials: AC
authors.lastname: Gelber
authors.affiliation: Northern Ontario School of Medicine, Greater Sudbury, Ontario, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Williams
authors.affiliation: Divisions of Rheumatology, University of Toronto, Toronto, Ontario, Canada. Electronic address: smittoo@mtsinai.on.ca.
authors.forename: Shikha
authors.initials: S
authors.lastname: Mittoo
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000209:etiology / Q000601:surgery*; D016040:Lung Transplantation / Q000401:mortality* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011184:Postoperative Period; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: interstitial; lung; rheumatoid arthritis; survival; transplantation