Impact of the pattern of interstitial lung disease on mortality in rheumatoid arthritis: A systematic literature review and meta-analysis
Section snippets
Background
Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis, affecting up to 1% of the general population [1]. Extra-articular features, especially pulmonary manifestations, can significantly increase morbidity and mortality among RA patients [2]. Consequently, lung disease has been identified to be the most over-represented cause of death in two recent reports of large U.S. cohorts [3], [4].
One of the most common forms of lung involvement in RA is interstitial lung disease
Data sources and search
Systematic literature searches were developed and conducted by a health sciences librarian trained in systematic reviews (HH). Searches were conducted within PubMed, Embase (Elsevier), and Cochrane Central Register of Controlled Trials (Wiley) using both subject headings and keywords. The searches were conducted from inception through September 12, 2017 and were limited to English. All identified studies were combined in a single reference manager file (EndNote) and duplicates were identified
Results
A total of 1719 articles were identified and 92 full text articles were assessed after records were screened. The most frequent reasons for exclusion upon full text review were lack of ILD pattern description and lack of mortality data. One of the studies was excluded because it focused primarily on a group comparison of UIP with “overlap syndromes” vs. NSIP and cryptogenic organizing pneumonia (COP) [5]. Ten studies fulfilled our eligibility criteria and were included in the meta-analysis (
Discussion
In this systematic literature review and meta-analysis including 10 studies and 1256 RA patients with ILD, we observed that the mortality risk ratio for UIP pattern of ILD in RA-ILD is higher as compared to other patterns of ILD, although there was substantial heterogeneity. We tried to address the heterogeneity by sub-group analysis of UIP versus NSIP pattern or other referent group but the results did not change. Recent studies have shown that the extent of lung involvement and pulmonary
Conclusions
In summary, our results highlight the impact the UIP pattern of ILD has on the survival of RA patients. Using a meta-analytic approach, we found UIP pattern to be associated with a higher mortality risk compared to other patterns of RA-ILD. However, there was substantial heterogeneity and a limited number of included studies. Also, when accounting for pulmonary physiology, studies did not find a difference in mortality between the two ILD patterns. This highlights the importance of the
Declaration of Competing Interest
All the authors have no conflicts of interest and did not receive any funding or honorarium from any sources.
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2022, Medical Journal Armed Forces IndiaCitation Excerpt :In previous studies using various older definitions, 23–52% subjects were found to develop progressive fibrosis.8,31,32 Other studies have reported that older age, male gender, lower DLCO, RA disease activity score, high-titer RF, UIP pattern, presence of honeycombing and the extent of reticulation, traction bronchiectasis, honeycombing, and fibrosis are significant predictors of mortality in RA-ILD.8,31,33,34 Our study suggests that the same features of honeycombing and traction bronchiectasis might also be the risk factors for the PF phenotype.