Evaluation of morbitide, mortality and prognosis in patients in Hacettepe Rheumatology Clinic with Rheumatoid Arthritis-associated interstitial lung disease

The aim of the study was to investigate of pulmonary involvement in patients with rheumatoid arthritis by non-invasive methods which are pulmonary function tests (PFT) and high resolution computed tomography (HRCT) and to determine the treatment choices, continuity of drug treatment, mortality, prognosis and also to assess clinical and laboratory findings associated with pulmonary involvement types. Patients (n=156, 30.8% male) who had thorax BT and were diagnosed with rheumatoid arthritis interstitial lung disease (RA ILD) admitted to our clinic between 01.01.2010 and 30.09.2018 were included in the study and the diagnosis was confirmed by three different radiologists. Clinical and laboratory data which were already available before were recorded for all patients. Data collected retrospectively were evaluated with appropriate statistical methods. After radiological evaluation, ILD subtypes were NSIP: 51 (32.6%), UIP: 89 (57%), AD: 16 (10.2%). The age of diagnosis of RA was 55.5 (12.1) years, the age of symptoms of ILD was 60.7 (11.5) years, the age of diagnosis of ILD was 62.7 (9.7) years, and the age of death was 70.7 (47.8-85.7) years, the duration of follow-up due to ILD was 4,5 (3,9-5) years and the time between diagnosis of RA and ILD was 6.3 (7.3) years. Forty patients (25.6%) died. The 5-year survival rate was 78%. Mortality was higher in patients with UIP than with NSIP and AD (log-rank 0.004). Furthermore, as the time between RA and ILD was shorter and pleural effusion was present, death ratio was more. According to multivariate analysis results, ILD-RA interval shorter than 3 years, presence of UIP and presence of pleural effusion increased mortality by 4.3, 10.3 and 14.4 times, respectively. Progression was detected in 41.5% of the patients who underwent control CT. Biological treatment rate was found 44.2%. Pulse steroid and cyclophosphamide were found to be used significantly more in the dying patient group, and recently, rituximab was the more preferred biological agent in the ILD group. Initial chest radiography for the patients who have got a recent diagnosis of RA may be useful and also HRCT may be useful to diagnose ILD in suspected patients.