Abstract
BackgroundInterstitial lung disease (ILD) is a common and potentially life-threatening complication for rheumatoid arthritis (RA) patients. However, there is a lack of clear prognostic factors in rheumatoid arthritis-associated interstitial lung disease (RA-ILD) patients. The purpose of this study was to complete a systematic review and meta-analysis of the factors associated with mortality in RA-ILD patients.MethodsMedline, EMBASE and the Cochrane Library were searched up to September 1, 2020. The Newcastle–Ottawa Scale (NOS) was applied to assess the methodological quality of the eligible studies. Study characteristics and magnitude of effect sizes were extracted. Then, pooled hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) and pooled risk ratios (RRs) with 95% CIs were calculated to assess the factors associated with mortality in RA-ILD.ResultsTwenty-three of 3463 articles were eligible, and ten factors associated with mortality for RA-ILD were evaluated in the meta-analysis. Older age (HRs = 1.04, 95% CI 1.03–1.05), male sex (HRs = 1.44, 95% CI 1.21–1.73), having a smoking history (HRs = 1.42, 95% CI 1.03–1.96), lower diffusing capacity of the lung for carbon monoxide (DLCO)% predicted (HRs = 0.98, 95% CI 0.97–1.00), forced vital capacity (FVC)% predicted (HRs = 0.99, 95% CI 0.98–1.00), composite physiological index (CPI) (HRs = 1.04, 95% CI 1.02–1.06), usual interstitial pneumonia (UIP) pattern on HRCT (HRs = 1.88, 95% CI 1.14–3.10 and RRs = 1.90, 95% CI 1.50–2.39), emphysema presence (HRs = 2.31, 95% CI 1.58–3.39), and acute exacerbation of ILD (HRs = 2.70, 95% CI 1.67–4.36) were associated with increased mortality in RA-ILD, whereas rheumatoid factor (RF) positive status was not associated.ConclusionsThrough this systematic review and meta-analysis, we found that older age, male sex, smoking history, higher CPI, lower DLCO% predicted, lower FVC% predicted, UIP pattern on HRCT, emphysema presence and acute exacerbation of ILD were associated with an increased risk of mortality in RA-ILD.
Highlights
Interstitial lung disease (ILD) is a common and potentially life-threatening complication for rheumatoid arthritis (RA) patients
Due to moderate heterogeneity across the studies (I2:63.4%, P = 0.008), the hazard ratios (HRs) were pooled in the random-effect model (HRs = 1.88, 95% Confidence interval (CI) 1.14–3.10, P = 0.014) and the results showed that the presence of the usual interstitial pneumonia (UIP) pattern was associated with mortality in the meta-analysis (Fig. 3A) [6, 25, 27, 28, 30, 35, 37, 39]
We identified nine statistically significant factors associated with increased mortality: older age, male sex, smoking history, lower DLCO% predicted, lower forced vital capacity (FVC)% predicted, higher composite physiological index (CPI), UIP pattern on high-resolution computed tomography (HRCT), emphysema presence and acute exacerbation of ILD
Summary
Interstitial lung disease (ILD) is a common and potentially life-threatening complication for rheumatoid arthritis (RA) patients. There is a lack of clear prognostic factors in rheumatoid arthritis-associated interstitial lung disease (RA-ILD) patients. The purpose of this study was to complete a systematic review and meta-analysis of the factors associated with mortality in RA-ILD patients. Rheumatoid arthritis (RA) is an autoimmune, inflammatory arthritis with extra-articular manifestations in up to 50% of patients [1] Among those manifestations, clinical and subclinical interstitial lung disease (ILD) are the most frequent extra-articular manifestations with increased morbidity and mortality, and it can be detected in 10–60% of RA patients [2, 3]. Multiple studies have previously investigated prognostic factors of RA-ILD. These findings were derived from retrospective studies with small sample sizes and the importance of their findings was unclear in isolation
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