Managing RA-associated lung disease could improve survival

The risk of interstitial lung disease (ILD) is increased in patients who have rheumatoid arthritis (RA) compared with the general population. ILD has a devastating effect on survival in patients with RA.

Bongartz and coworkers assembled a population-based incidence cohort of patients with RA and a matched cohort of persons without RA and monitored them longitudinally. They compared the incidence of ILD in the 2 groups, investigated predictors, and explored the impact of ILD on survival.

The lifetime risk of ILD was 7.7% for patients who had RA and 0.9% for those who did not. At greater risk for ILD were patients with RA who were older at disease onset, men, and persons with more severe RA. The risk of death for patients with RA who had ILD was 3 times higher than for those without ILD. The median survival of patients with RA after a diagnosis of ILD was 2.6 years, significantly lower than the expected median survival of patients who had RA but not ILD. The RA cohort had an excess mortality of 15.9%; removing the effect of ILD on survival reduced it by 2.1%.

The authors suggested that the prevention and management of RA-associated ILD could significantly improve survival and that individualizing clinical decisions in balancing the risks and benefits of treatment is important.