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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 identied 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 inammation to alter the risk or progression of RA-ILD in the future.