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Current Issue

Target Lung Disease to Improve Rheumatoid Arthritis Survival

by U.S. Medicine

February 2, 2019

OMAHA, NE – A recent VA study emphasized the importance of targeting comorbid lung disease to improve long-term outcomes in rheumatoid arthritis (RA).

The report in Clinical Rheumatology discussed the effect of chronic lung diseases (CLD) on survival in RA.1

A study team led by researchers from the Nebraska-Western Iowa VA Healthcare System identified CLD and cardiovascular disease in participants in the Veterans Affairs Rheumatoid Arthritis (VARA) Registry.

Among the information collected was demographics, smoking status, RA characteristics including Disease Activity Score in 28 joints (DAS28), and disease-modifying anti-rheumatic drug (DMARD) use.

The study team  evaluated associations of CLD with survival using the multivariable Cox regression models. Among  the 2,053 mostly male RA cohort, 554 (27%) had CLD at enrollment.

Researchers determined that mortality risk was increased 1.51-fold (95% CI 1.26-1.81) in RA patients with CLD after multivariable adjustment, a risk that was similar to that observed with CVD (HR CLD alone 1.46 [1.03-2.06]; CVD alone 1.62 [1.35-1.94]).

In addition, the study documented that survival was significantly reduced in those with interstitial lung disease (ILD) as well as other forms of CLD.

On the other hand, mortality risk with methotrexate and biologic use was not different in those with CLD compared to those without (p interaction ≥ 0.15) using multiple exposure definitions and propensity score adjustment.

“Mortality risk is significantly increased in RA patients with CLD,” study authors concluded. “This risk is attributable not only to ILD but also to other chronic lung conditions and does not appear to be substantially greater in those receiving methotrexate or biologic therapies. Comorbid lung disease should be targeted as a means of improving long-term outcomes in RA.”

1. England BR, Sayles H, Michaud K, Thiele GM, Poole JA, Caplan L, Sauer BC, Cannon GW, Reimold A, Kerr GS, Baker JF, Mikuls TR. Chronic lung disease in U.S. Veterans with rheumatoid arthritis and the impact on survival. Clin Rheumatol. 2018 Nov;37(11):2907-2915. doi: 10.1007/s10067-018-4314-9. Epub 2018 Oct 2. PubMed PMID: 30280369.



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