Interstitial Lung Disease in Patients With Rheumatoid Arthritis or Psoriatic Arthritis Initiating Biologics and Controls: Data From 5 Nordic Registries.

IF 3.6 2区 医学 Q2 RHEUMATOLOGY Journal of Rheumatology Pub Date : 2024-11-01 DOI:10.3899/jrheum.2024-0252
Sella Aarrestad Provan, Lotta Ljung, Eirik Klami Kristianslund, Brigitte Michelsen, Till Uhlig, Thorarinn Jonmundsson, Joe Sexton, Bjorn Gudbjornsson, Daniela Di Giuseppe, Merete Lund Hetland, Gudrun Bjork Reynisdottir, Bente Glintborg, Heikki Relas, Kalle Aaltonen, Tore Kristian Kvien, Johan Askling
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Abstract

Objective: Interstitial lung disease (ILD) is one of the most common pulmonary manifestations of rheumatoid arthritis (RA), but its prevalence has not been investigated in psoriatic arthritis (PsA). The role of methotrexate (MTX) in ILD development remains under debate. This study (1) compares the incidences of ILD in patients with RA or PsA initiating a first biologic disease-modifying antirheumatic drug (bDMARD) to that in the general population, and (2) investigates the role of MTX comedication on ILD incidence.

Methods: Patients were identified in 5 rheumatology registries. Demographics, MTX use, and disease activity were retrieved. Matched subjects from the general population were available from 4 countries. Incidence of ILD during follow-up of up to 5 years was assessed through national patient registries. Subjects with prior ILD were excluded. Adjusted hazard ratios (HRs) were calculated for ILD incidence in patients vs the general population, and for MTX users vs nonusers.

Results: During follow-up of 29,478 patients with RA and 10,919 patients with PsA initiating a first bDMARD and 362,087 population subjects, 225, 23, and 251 cases of ILD were identified, respectively. HRs for ILD (vs population subjects) were 9.7 (95% CI 7.97-11.91) in RA and 4.4 (95% CI 2.83-6.97) in PsA. HRs for ILD with MTX comedication (vs nonuse) were 1.0 (95% CI 0.72-1.25) in RA and 0.9 (95% CI 0.38-2.05) in PsA.

Conclusion: Among patients with RA and PsA initiating a bDMARD, the risk of ILD was higher than in the general population, and was highest in RA. MTX comedication was not a risk determinant for ILD.

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开始使用生物制剂的类风湿或银屑病关节炎患者和对照组的间质性肺病--来自五个北欧登记处的数据。
目的:间质性肺病(ILD)是类风湿性关节炎(RA)最常见的肺部表现之一,但尚未对其在银屑病关节炎(PsA)中的发病率进行调查。甲氨蝶呤在 ILD 发生中的作用仍存在争议。本研究比较了首次使用生物制剂改变病情抗风湿药(bDMARD)的RA或PsA患者与普通人群的ILD发病率,并调查了甲氨蝶呤联合用药对ILD发病率的影响:方法:从五个风湿病登记册中识别患者。方法:从五个风湿病登记册中确定患者,并检索其人口统计学特征、甲氨蝶呤使用情况和疾病活动性。从四个国家的普通人群中找到了匹配对象。在长达五年的随访期间,通过国家患者登记册评估了ILD的发病率。曾患 ILD 的受试者被排除在外。计算了患者与普通人群、甲氨蝶呤使用者与非使用者的ILD发病率调整危险比(HR):结果:在对29 478名首次使用bDMARD的RA患者和10 919名PsA患者以及362 087名普通人群进行随访期间,分别发现了225、23和251例ILD病例。RA和PsA患者ILD的HR值分别为9.7(95% CI为8.0,11.9)和4.4(2.8,7.0)(与人群相比)。联合使用甲氨蝶呤(与不使用甲氨蝶呤相比)的ILD HRs在RA为0.9(95% CI 0.7,1.2),在PsA为1.0(95% CI 0.2,2.2):结论:在开始使用双嘧达莫联合用药的RA和PsA患者中,发生ILD的风险高于普通人群,其中RA患者的风险最高。甲氨蝶呤联合用药并不是导致ILD的风险因素。
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来源期刊
Journal of Rheumatology
Journal of Rheumatology 医学-风湿病学
CiteScore
6.50
自引率
5.10%
发文量
285
审稿时长
1 months
期刊介绍: The Journal of Rheumatology is a monthly international serial edited by Earl D. Silverman. The Journal features research articles on clinical subjects from scientists working in rheumatology and related fields, as well as proceedings of meetings as supplements to regular issues. Highlights of our 41 years serving Rheumatology include: groundbreaking and provocative editorials such as "Inverting the Pyramid," renowned Pediatric Rheumatology, proceedings of OMERACT and the Canadian Rheumatology Association, Cochrane Musculoskeletal Reviews, and supplements on emerging therapies.
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