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RA Disease Activity Drives Lung Complications

A longitudinal study from the BRASS registry shows that increase rheumatoid arthritis (RA) disease activity increases the risk of RA-associated interstitial lung disease (RA-ILD).

RA patients without RA-ILD at baseline, enrolled in the Brigham RA Sequential Study (BRASS, 2003–2016), were followed from 2003-2016 with serial clinical, DAS28, serologic and imaging assessments. 

From a total of 1,419 RA (mean age 55.8 years; 2/3 seropositive) they identied 85 incident cases of RA-ILD after a mean follow- up duration of 8.9 years per patient. 

Those with moderate/high disease activity group had a two fold increase (HR of 2.22;95% CI 1.28–3.82) for RA-ILD compared to the remission/low disease activity group.

The Risk of RA-ILD according to DAS 28 disease activity:

  • Remission: HR 1.00 (reference)
  • Low disease activity: HR 1.41 (95% CI 0.61–3.28)
  • Moderate disease activity: HR 2.08 (95% CI 1.06–4.05)
  • High disease activity: HR 3.48 (95% CI 1.64–7.38) (P for trend = 0.001).

For each unit increase in the DAS28, the risk of RA-ILD increased by 35%. Results were similar in analyses adjusted for of methotrexate, glucocorticoids, bone erosions, or rheumatoid nodules.

These findings suggest the importance of reducing disease activity and systemic inammation to alter the risk or progression of RA-ILD in the future.

The author has no conflicts of interest to disclose related to this subject

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