RA Lung Disease Portends Poor Outcomes Save

A retrospective Harvard affiliates study shows that rheumatoid arthritis (RA) patients with lung disease have higher mortality, especially respiratory and infection-related mortality than those without lung disease (LD).

A retrospective cohort study using the Mass General Brigham Biobank patients compared RA-LD cases to those without (RA-no LD) with comparators matched by calendar date, age, sex, and RA duration. RA-LD was verified imaging and subclassified as RA-associated interstitial lung disease (RA-ILD) and/or RA-associated bronchiectasis (RA-BR). Outcomes included total and cause-specific mortality (respiratory, cancer, cardiovascular, infection). 

A total of 221 RA-LD cases (151 RA-ILD and 70 RA-BR) were compared to 980 RA-no LD comparators. Those with RA-LD had:

• Higher total mortality (34.0 vs 13.1 per 1,000 person-years; HR 1.97, 95%CI 1.43–2.70). 
• More Infection-related mortality (7% vs 3%, p= 0.002)
• Increased respiratory mortality (13.1 vs 1.7 per 1,000 person-years; sdHR 6.68, 95%CI 3.19–14.00) 
• Increased lung infection-related mortality (6.3 vs 1.4 per 1,000 person-years; sdHR 3.33, 95%CI 1.32–8.37), especially in RA-ILD patients. 
• RA-related bronchiectasis patients had higher cancer mortality (8.6 vs 2.3 per 1,000 person-years; sdHR 2.89, 95%CI 1.11–7.47).

These data emphasize the need for earlier diagnosis and improved treatments for RA-LD, including infection prevention, and vigilant cancer surveillance.