ACR CONVERGENCE 2020—Moderated by Bill St.Clair, MD, MACR, an ACR past president and a professor of medicine and immunology at Duke University Medical Center, Durham, N.C., an abstract session on Friday, Nov. 6, focused on the diagnosis, manifestations and outcomes of rheumatoid arthritis (RA), with a focus on interstitial lung disease.
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RA with ILD
Jeffrey Sparks, MD, MSc, an assistant professor of medicine at Brigham and Women’s Hospital, Boston, presented the results of two studies: “Prevalence, Incidence, and Cause-Specific Mortality of Rheumatoid Arthritis-Associated Interstitial Lung Disease Among Older Patients with Rheumatoid Arthritis: A Nationwide Cohort Study” (abstract 0489) and “Fine Specificity Anti-Citrullinated Protein Antibodies as Biomarkers for Prediction of Incident Rheumatoid Arthritis-Associated Interstitial Lung Disease” (abstract 0490).1,2
Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is one of the most serious extra-articular RA manifestations, and its prevalence may be increasing. According to Dr. Sparks, “RA-ILD is associated with a median overall survival of only three to eight years.” Thus, Dr. Sparks and his colleagues investigated the prevalence, incidence and cause-specific mortality of RA-ILD using a recently validated claims-based algorithm in a retrospective cohort study using U.S. claims data from Medicare (2008–17).
The researchers concluded that RA-ILD was present or developed in nearly 5% of “older” patients with RA (Note: The abstract did not define older; however, the study population comprised Medicare patients, so the patients were 65 or older.) RA-ILD was associated with excess total mortality that was not explained by measured factors. They confirmed the association of male sex and smoking with incident RA-ILD. They further noted that biologic disease-modifying anti-rheumatic drug (DMARD) use and glucocorticoid use were associated with incident RA-ILD. Patients with RA-ILD had a strongly associated increased risk of respiratory mortality than patients with RA without ILD.
In the second study presentation, Dr. Sparks said the researchers investigated fine specificity anti-citrullinated protein antibodies (ACPA) and the subsequent risk of RA-ILD. They were able to identify several fine specificity ACPA associated with subsequent risk of RA-ILD that may inform pathogenesis. In particular, their study showed that “autoimmunity to a specific citrullinated epitope of filaggrin was associated with RA-ILD across all isotypes investigated and is potentially a novel predictive biomarker for RA-ILD. … These results suggest that fine specificity ACPA biomarkers may have utility in RA-ILD prediction.”
RA & Pulmonary Function
Lauren Prisco, BA, the clinical research coordinator at Brigham and Women’s Hospital, presented the results of a study on the relationship between RA and pulmonary function (abstract 0491).3