The Impact of Disease Severity Measures on Survival in U.S. Veterans with Rheumatoid Arthritis-Associated Interstitial Lung Disease

Details

• Personal Author:
  Ascherman DP ; Baker JF ; Brooks R ; England BR ; Kerr GS ; Kunkel G ; Lazaro D ; Mikuls TR ; Monach PA ; Poole JA ; Reimold AM ; Roul P ; Singh N ; Wysham KD ; Yang Y
• Description:
  Objectives. To determine whether rheumatoid arthritis (RA) and interstitial lung disease (ILD) severity measures are associated with survival in patients with RA-ILD. Methods. We studied US veterans with RA-ILD participating in a multicentre, prospective RA cohort study. RA disease activity (28-joint DAS [DAS28-ESR]) and functional status (multidimensional HAQ [MDHAQ]) were collected longitudinally while pulmonary function tests (forced vital capacity [FVC], diffusing capacity for carbon monoxide) were obtained from medical records. Vital status and cause of death were determined from the National Death Index and administrative data. Predictors of death were assessed using multivariable Cox regression models adjusting for age, sex, smoking status, ILD duration, comorbidity burden and medications. Results. We followed 227 RA-ILD participants (93% male and mean age of 69 years) over 1073 person-years. Median survival after RA-ILD diagnosis was 8.5 years. Respiratory diseases (28%) were the leading cause of death, with ILD accounting for 58% of respiratory deaths. Time-varying DAS28-ESR (adjusted hazard ratio [aHR] 1.21; 95% CI: 1.03, 1.41) and MDHAQ (aHR 1.85; 95% CI: 1.29, 2.65) were separately associated with mortality independent of FVC and other confounders. Modelled together, the presence of either uncontrolled disease activity (moderate/high DAS28-ESR) or FVC impairment (<80% predicted) was significantly associated with mortality risk. Those with a combination of moderate/high disease activity and FVC <80% predicted had the highest risk of death (aHR 4.43; 95% CI: 1.70, 11.55). Conclusion. Both RA and ILD disease severity measures are independent predictors of survival in RA-ILD. These findings demonstrate the prognostic value of monitoring the systemic features of RA-ILD. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Lung Diseases Mortality Occupational Health Respiratory System Respiratory Tract Diseases Safety
• Keywords:
  Author Keywords: RA Cohort Studies Disease Activity Interstitial Lung Disease Lung Disease Military Personnel Mortality Mortality Rates Pulmonary Function Tests Respiratory Diseases Rheumatoid Disorders

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• ISSN:
  1462-0324
• Document Type:
  Text
• Funding:
  Grant ; Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  District of Columbia ; Massachusetts ; Nebraska ; New York ; OSHA Region 1 ; OSHA Region 10 ; OSHA Region 2 ; OSHA Region 3 ; OSHA Region 6 ; OSHA Region 7 ; OSHA Region 8 ; Pennsylvania ; Texas ; Utah ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  61
• Issue:
  12
• NIOSHTIC Number:
  nn:20066524
• Citation:
  Rheumatology 2022 Dec; 61(12):4667-4677
• Contact Point Address:
  Bryant R. England, VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA
• Email:
  Bryant.england@unmc.edu
• Federal Fiscal Year:
  2023
• NORA Priority Area:
  Agriculture, Forestry and Fishing
• Performing Organization:
  University of Nebraska Medical Center
• Peer Reviewed:
  True
• Start Date:
  20210901
• Source Full Name:
  Rheumatology
• End Date:
  20250831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:01467ff526c006fbc8414695d4e49e14a27f1650b4e8677e0f2454974824a665278b7913fa1343a78c756ef69309c4eea4c6c5756cc3dbe46adedcc1de4b9ef9
• Download URL:
  https://stacks.cdc.gov/view/cdc/231107/cdc_231107_DS1.pdf
• File Type:
  [PDF - 479.01 KB ]