Rheumatoid arthritis lung disease: Determinants of radiographic and physiologic abnormalities

Academic Article

Abstract

  • Objective. To determine the prevalence and important clinical predictors of radiographic and physiologic abnormalities indicative of rheumatoid arthritis interstitial lung disease (RA-ILD). Methods. An unselected cohort of patients with a confirmed diagnosis of RA and known lung disease were identified (n = 336) and evaluated for RA disease activity and severity. Outcomes included abnormalities determined by the pulmonary function tests of forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLco), and/or chest radiographic findings of interstitial infiltrates. We used multivariable statistical modeling to determine the independent significance of cigarette smoking and other RA-specific factors on the pulmonary abnormalities of interest. Results. At least 1 of the 3 abnormal findings was identified by pulmonary tests in 32.4% of all patients. These abnormal findings included an FVC <80% of predicted in 42 patients, a DLco <80% of predicted in 64 patients, and evidence of radiographic interstitial infiltrates in 40 patients. After statistical adjustment for confounding factors, pack-years of cigarette smoking remained a significant predictor of low DLco (β = -0.07, 95% confidence interval [95% CI] -0.09, -0.04), low FVC (β = -0.003, 95% CI -0.006, -0.0004), and interstitial abnormalities on chest radiograph (odds ratio for ≤25 pack-years = 3.76, 95% CI 1.59, 8.88). The Health Assessment Questionnaire (HAQ) Disability Index (DI) was also an important risk factor for the decline in both the DLco (β = -1.15, 95% CI - 2.00, -0.30) and FVC (β = -0.23, 95% CI -0.32, -0.13). Conclusion. Although RA disease activity/severity (particularly as defined by the HAQ DI) was important, smoking was the most consistent independent predictor of radiographic and physiologic abnormalities suggestive of ILD in RA.
  • Authors

    Digital Object Identifier (doi)

    Author List

  • Saag KG; Kolluri S; Koehnke RK; Georgou TA; Rachow JW; Hunninghake GW; Schwartz DA
  • Start Page

  • 1711
  • End Page

  • 1719
  • Volume

  • 39
  • Issue

  • 10