Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts
Patrick A. Kiely,Amanda Busby,Elena Nikiphorou,Keith Sullivan,David A. Walsh,Paul Creamer,Josh Dixey,Adam Young +7 more
TLDR
Exposure to methotrexate (MTX) treatment was not associated with an increased risk of rheumatoid arthritis interstitial lung disease (RA-ILD), and evidence suggested that MTX may delay the onset of ILD.Abstract:
Objectives To assess predictive factors for rheumatoid arthritis interstitial lung disease (RA-ILD) in two early rheumatoid arthritis (RA) inception cohorts with a focus on methotrexate (MTX) exposure. Design Multicentre prospective early RA inception cohort studies; the early RA study (ERAS) and the early RA network (ERAN). Setting Secondary care, ERAS nine centres, ERAN 23 centres in England, Wales and Ireland. Participants Patients with new diagnosis of RA, n=2701. Standardised data including demographics, drug therapies and clinical outcomes including the presence of RA-ILD were collected at baseline, within 3–6 months, at 12 months and annually thereafter. Primary and secondary outcome measures Primary outcome was the association of MTX exposure on RA-ILD diagnosis. Secondary outcomes were the association of demographic, comorbid and RA-specific factors on RA-ILD diagnosis and the association of MTX exposure on time to RA-ILD diagnosis. Results Of 92 eligible ILD cases, 39 occurred in 1578 (2.5%) MTX exposed and 53 in 1114 (4.8%) non-MTX exposed cases. The primary analysis of RA-ILD cases only developing after any conventional synthetic disease-modifying antirheumatic drug treatment (n=67) showed MTX exposure not to be associated with incident RA-ILD (OR 0.85, 95% CI 0.49 to 1.49, p=0.578) and a non-significant trend for delayed ILD diagnosis (OR 0.54, 95% CI 0.28 to 1.06, p=0.072). In an extended analysis including RA-ILD cases present at RA diagnosis (n=92), MTX exposure was associated with a significantly reduced risk of incident RA-ILD (OR 0.48, 95% CI 0.3 to 0.79, p=0.004) and longer time to ILD diagnosis (OR 0.41, 95% CI 0.23 to 0.75, p=0.004). Other independent baseline associations with incident RA-ILD were higher age of RA onset, ever smoking, male gender, rheumatoid nodules and longer time from first RA symptom to first outpatient visit. Conclusions MTX treatment was not associated with an increased risk of RA-ILD diagnosis. On the contrary, evidence suggested that MTX may delay the onset of ILD.read more
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Methotrexate and rheumatoid arthritis associated interstitial lung disease.
Pierre-Antoine Juge,Joyce S. Lee,Jessica Lau,Leticia Kawano-Dourado,Jorge Rojas Serrano,Marco Sebastiani,Gouri Koduri,Eric L. Matteson,Karina Bonfiglioli,Marcio Valente Yamada Sawamura,Ronaldo Adib Kairalla,Lorenzo Cavagna,Emanuele Bozzalla Cassione,Andreina Teresa Manfredi,Mayra Mejía,Pedro Rodríguez-Henriquez,Montserrat I González-Pérez,Ramcés Falfán-Valencia,Ivette Buendía-Roldán,Gloria Pérez-Rubio,Esther Ebstein,Steven Gazal,Steven Gazal,Raphael Borie,Sébastien Ottaviani,Caroline Kannengiesser,Benoit Wallaert,Yurdagul Uzunhan,Hilario Nunes,Dominique Valeyre,Nathalie Saidenberg-Kermanac’h,Marie-Christophe Boissier,Lidwine Wemeau-Stervinou,René-Marc Flipo,Sylvain Marchand-Adam,Pascal Richette,Pascal Richette,Yannick Allanore,Yannick Allanore,Claire Dromer,Marie-Elise Truchetet,Christophe Richez,Thierry Schaeverbeke,Huguette Lioté,Gabriel Thabut,Kevin D. Deane,Joshua J. Solomon,Tracy J. Doyle,Jay H. Ryu,Ivan O. Rosas,V. Michael Holers,Catherine Boileau,Marie-Pierre Debray,Raphaël Porcher,David A. Schwartz,Robert Vassallo,Bruno Crestani,Philippe Dieudé +57 more
TL;DR: The results suggest that MTX use is not associated with an increased risk of RA-ILD in patients with RA, and that ILD was detected later in MTX-treated patients.
Journal ArticleDOI
Methotrexate-Associated Pneumonitis and Rheumatoid Arthritis-Interstitial Lung Disease: Current Concepts for the Diagnosis and Treatment
TL;DR: Although no clear guidelines exist for RA-ILD treatment, glucocorticoids and conventional disease modifying antirheumatic drugs (DMARDs) like MTX or leflunomide, as well as treatment with biologic DMARDs can be effective.
Journal ArticleDOI
Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows.
Giulia Cassone,Andreina Teresa Manfredi,Caterina Vacchi,Fabrizio Luppi,Francesca Coppi,Carlo Salvarani,Marco Sebastiani +6 more
TL;DR: A framework for the management of RA-ILD patients is suggested and a research agenda is outlined to fill the gaps in knowledge about this challenging patient cohort.
Journal ArticleDOI
Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicenter retrospective study
Andreina Teresa Manfredi,Giulia Cassone,Federica Furini,Elisa Gremese,Vincenzo Venerito,Fabiola Atzeni,Eugenio Arrigoni,Giovanni Della Casa,Stefania Cerri,Marcello Govoni,Luca Petricca,Florenzo Iannone,Carlo Salvarani,Marco Sebastiani +13 more
TL;DR: Interstitial lung disease (ILD) is the most severe extra‐articular manifestation of rheumatoid arthritis (RA) and its therapeutic approach is still debated.
Journal ArticleDOI
Abatacept in interstitial lung disease associated with rheumatoid arthritis: national multicenter study of 263 patients
C. Fernández-Díaz,Santos Castañeda,Rafael Benito Melero-González,Francisco Ortiz-Sanjuán,Antonio Juan-Mas,Carmen Carrasco-Cubero,Ivette Casafont-Solé,Alejandro Olivé,Samantha Rodríguez-Muguruza,Raquel Almodóvar-González,Raul Castellanos-Moreira,Sebastián C Rodríguez-García,Clara Aguilera-Cros,Ignacio Villa,Sergio Ordóñez-Palau,Erique Raya-Alvarez,Pilar Morales-Garrido,C. Ojeda-Garcia,Manuel J Moreno-Ramos,María Gema Bonilla Hernán,Iñigo Hernández Rodríguez,Mireia López-Corbeto,José L. Andreu,Juan R D Jiménez de Aberásturi,A. Ruibal-Escribano,Rosa Expósito-Molinero,Trinidad Pérez-Sandoval,Ana María López-Robles,Patricia Carreira-Delgado,Natalia Mena-Vázquez,A. Urruticoechea-Arana,Cilia Peralta-Ginés,Luis Arboleya-Rodríguez,F Javier Narváez García,Deseada Palma-Sánchez,Evelin C Cervantes Pérez,O. Maiz-Alonso,María N Alvarez-Rivas,Julia Fernández-Melón,Paloma Vela Casasempere,Iván Cabezas-Rodríguez,Iván Castellvi-Barranco,Carmen González-Montagut,J. M. Blanco-Madrigal,Natividad del Val del Amo,María C Fito,Manuel Rodríguez-Gómez,Eva Salgado-Pérez,Blanca Garcia-Magallon,Cristina Hidalgo-Calleja,Ruben López-Sánchez,Sabela Fernández-Aguado,Jesús C Fernández-López,Sonia Castro-Oreiro,Isabel Serrano-García,A. García-Valle,Susana Romero-Yuste,Lorena Expósito-Pérez,Lorena Pérez-Albadalejo,Ángel García-Aparicio,Neus Quillis-Marti,José Antonio Bernal-Vidal,Javier Loricera-García,José L. Hernández,Miguel A. González-Gay,Ricardo Blanco +65 more
TL;DR: ABA may be an effective and safe treatment for patients with RA-ILD and after a median follow-up of 12 months the following variables did not show worsening: dyspnoea, MRC, FVC, DLCO, HRCT and CS-sparing effect.
References
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EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs
Josef S Smolen,Robert Landewé,Ferdinand C. Breedveld,Maxime Dougados,Paul Emery,Cécile Gaujoux-Viala,Simone L Gorter,Rachel Knevel,Jackie L Nam,Monika Schoels,Daniel Aletaha,Maya H Buch,Laure Gossec,T.W.J. Huizinga,Johannes W. J. Bijlsma,G.-R. Burmester,B. Combe,Maurizio Cutolo,Cem Gabay,Juan J. Gomez-Reino,Marios Kouloumas,Tore K Kvien,E. Martin-Mola,Iain B. McInnes,Karel Pavelka,P.L.C.M. van Riel,M. Scholte,David Scott,T. Sokka,Guido Valesini,R. van Vollenhoven,Kevin L. Winthrop,John B. Wong,A. Zink,D. van der Heijde +34 more
TL;DR: Recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA based on evidence and expert opinion.
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Validation of rheumatoid arthritis improvement criteria that include simplified joint counts.
TL;DR: In this paper, the validity of response criteria for rheumatoid arthritis (RA) that included 28-joint counts instead of more comprehensive joint counts was investigated. But the results showed no differences between treatment groups in terms of functional capacity and joint damage.
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