title: Predictors of mortality in rheumatoid arthritis-associated interstitial lung disease.
abstract: Interstitial lung disease (ILD) is a common pulmonary manifestation of rheumatoid arthritis. There is lack of clarity around predictors of mortality and disease behaviour over time in these patients.We identified rheumatoid arthritis-related interstitial lung disease (RA-ILD) patients evaluated at National Jewish Health (Denver, CO, USA) from 1995 to 2013 whose baseline high-resolution computed tomography (HRCT) scans showed either a nonspecific interstitial pneumonia (NSIP) or a "definite" or "possible" usual interstitial pneumonia (UIP) pattern. We used univariate, multivariate and longitudinal analytical methods to identify clinical predictors of mortality and to model disease behaviour over time.The cohort included 137 subjects; 108 had UIP on HRCT (RA-UIP) and 29 had NSIP on HRCT (RA-NSIP). Those with RA-UIP had a shorter survival time than those with RA-NSIP (log rank p=0.02). In a model controlling for age, sex, smoking and HRCT pattern, a lower baseline % predicted forced vital capacity (FVC % pred) (HR 1.46; p<0.0001) and a 10% decline in FVC % pred from baseline to any time during follow up (HR 2.57; p<0.0001) were independently associated with an increased risk of death.Data from this study suggest that in RA-ILD, disease progression and survival differ between subgroups defined by HRCT pattern; however, when controlling for potentially influential variables, pulmonary physiology, but not HRCT pattern, independently predicts mortality.
authors.affiliation: Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA SolomonJ@NJHealth.org.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Solomon
authors.affiliation: Division of Radiology, National Jewish Health, Denver, CO, USA.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Chung
authors.affiliation: Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Cosgrove
authors.affiliation: Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: M Kristen
authors.initials: MK
authors.lastname: Demoruelle
authors.affiliation: Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
authors.forename: Evans R
authors.initials: ER
authors.lastname: Fernandez-Perez
authors.affiliation: Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Aryeh
authors.initials: A
authors.lastname: Fischer
authors.affiliation: Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Frankel
authors.affiliation: Department of Radiology, University of Kentucky, Lexington, KY, USA.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Hobbs
authors.affiliation: Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
authors.forename: Tristan J
authors.initials: TJ
authors.lastname: Huie
authors.affiliation: Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Ketzer
authors.affiliation: Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Amar
authors.initials: A
authors.lastname: Mannina
authors.affiliation: Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Olson
authors.affiliation: Pontificia Universidad Católica Madre y Maestra, Santiago, Dominican Republic.
authors.forename: Gloria
authors.initials: G
authors.lastname: Russell
authors.affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tsuchiya
authors.affiliation: Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
authors.forename: Zulma X
authors.initials: ZX
authors.lastname: Yunt
authors.affiliation: Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO, USA.
authors.forename: Pearlanne T
authors.initials: PT
authors.lastname: Zelarney
authors.affiliation: Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Brown
authors.affiliation: Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Swigris
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011653:Pulmonary Diffusing Capacity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity