DMARDs for Patients With Rheumatoid Arthritis-Associated ILD

Fatima Alduraibi, MD

A majority of patients with rheumatoid arthritis-associated interstitial lung disease use non-biologic disease-modifying antirheumatic drugs (DMARDs) including azathioprine, mycophenolate mofetil, and mycophenolic acid, according to new findings presented at the Congress of Clinical Rheumatology East 2020 meeting.

Clinically significant interstitial lung disease occurs in nearly 10% of patients with rheumatoid arthritis. The condition leads to significant morbidity and premature mortality. The five-year mortality in usual interstitial pneumonia is greater than 50% while non-fibrotic nonspecific interstitial pneumonia with cellular or fibrotic pattern carries a more favorable prognosis.

While corticosteroids and DMARDs are used, treatment guidelines for the extra-articular manifestation of rheumatoid arthritis do not exist.

Fatima Alduraibi, MD, and investigators established a local rheumatoid arthritis-associated interstitial lung disease registry and aimed to use it to study the outcomes of patients with the condition.

Alduraibi and the team included adult patients with a diagnosis of rheumatoid arthritis and interstitial lung disease who were treated at the University of Alabama Birmingham between January 2010 and December 2019. The team reviewed charts to identify rheumatoid arthritis-associated interstitial lung disease based on ACR 1987 or 2010 ACR/EULAR criteria and an expert pulmonologist diagnosis.

The investigators collected data on demographics, antibody status, lifestyle habits, and pulmonary function measurements. Further, they gathered information on medications used to treat rheumatoid arthritis-associated interstitial lung disease.

Overall, 103 patients met the definition of rheumatoid arthritis-associated interstitial lung disease and were included in the study, and the team presented characteristics of 36 patients. The mean age of diagnosis of interstitial lung disease was 64 years old. A majority of the patients were women (57%) and 69% were Caucasian. Half of the patients were past smokers and 44% had never smoked.

The rheumatoid factor was positive in 72% of patients while the anticyclic citrullinated peptide was positive in 83% of the patients. Using high-resolution chest computed tomography scans, it was revealed 55% of patients had usual interstitial pneumonia and 17% has nonspecific interstitial pneumonia.

When the investigators looked at treatments for such patients, 39% were on azathioprine, 39% were on mycophenolate mofetil and mycophenolic acid, 11% were on rituximab, and 11% were on anti-fibrotics.

In univariable analysis the team found FVC and DLCO at 12 months were stable and there was no statistically significant change in FVC in the rituximab subgroup (P=.11).

The team noted further statistical analysis was still ongoing.

The study, “Outcomes of Patients with Rheumatoid arthritis (RA) Associated Interstitial Lung Disease (ILD) Treated with Immunosuppressive Medications,” was published as part of the Congress of Clinical Rheumatology East 2020 meeting.