TOPIC: Diffuse Lung Disease TYPE: Original Investigations PURPOSE: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease that confers a poor prognosis. Previously, immunoglobulin A (IgA) level has been used as a surrogate marker of transforming growth factor (TGF)-beta, an important mediator of pulmonary fibrosis, and increased IgA level was associated with worse outcomes in IPF [1]. Recent studies have also described associations between serum monocyte count and clinical outcomes in IPF [2]. Rheumatoid arthritis related interstitial lung disease (RA-ILD) has many similarities with IPF, including similar genetic risk, survival, and ILD pattern. We hypothesized that elevated IgA and monocyte count would correlate with clinical outcomes and ILD patterns in RA-ILD. METHODS: We performed a single-center, retrospective chart review of patients diagnosed with RA-ILD between 2010 and 2021 using an ICD9 and ICD10 based search. Of 256 patients who met our search criteria, 77 were included in the final analysis. Patients were included if they had serum IgA and monocyte count in the chart, a confirmed diagnosis of RA based on ACR/EULAR criteria, and ILD based on chart diagnosis and confirmatory imaging. Patients were excluded if they received rituximab prior to their blood draw. High resolution computed tomography images closest to the date of the blood draw were analyzed by consensus reads by two blinded thoracic radiologists using the 2018 ATS/ERS/JRS/ALAT guidelines. IgA level and monocyte count were compared to pulmonary function at time of blood draw, time to death or lung transplant, UIP pattern as well as sex, ethnicity and age. RESULTS: The mean and median IgA levels were 342.8 mg/dl and 329.0 mg/dl, respectively. There was no statistically significant association between IgA level and the UIP pattern (p = 0.689). IgA level was not associated with baseline FVC% predicted or baseline DLCO% predicted (p = 0.218 and p = 0.639). The effect of IgA level on overall survival is not significant in the simple Cox regression model [hazard ratio (HR) = 1.002, 95% confidence interval (CI) 0.999-1.004, p = 0.203].The mean and median absolute monocyte counts were 6.5×108 cells/liter and 6.0×108 cells/liter, respectively. There was no association between monocyte count and the UIP pattern (p = 0.762). Monocyte count was not associated baseline with FVC% predicted (p = 0.963) or baseline DLCO% predicted (p = 0.882). The effect of monocyte count on overall survival is not significant in the simple Cox regression model (HR = 1.099, 95% CI 0.449-2.690, p = 0.836). CONCLUSIONS: Serum IgA and monocyte concentration were not associated with important clinical outcomes in this RA-ILD cohort. This was a retrospective analysis, it may be that prospective, longitudinal analysis of IgA and monocyte count in RA-ILD could yield different results. CLINICAL IMPLICATIONS: N/A DISCLOSURES: No relevant relationships by Joe Johnstone, source=Web Response Consultant relationship with Boehringer Ingelheim Please note: $1001 - $5000 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Genentech Please note: $1001 - $5000 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Celgene Please note: $1001 - $5000 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Galapagos Please note: $1001 - $5000 by Joyce Lee, source=Web Response, value=Consulting fee Consultant relationship with Eleven P15 Please note: $1001 - $5000 by Joyce Lee, source=Web Response, value=Consulting fee No relevant relationships by Scott Matson, source=Web Response No relevant relationships by Sahil Pandya, source=Web Response No relevant relationships by Kristen Pope, source=Web Response No relevant relationships by Xiaosong Shi, source=Web Response No relevant relationships by Christopher Walker, source=Web Response
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