New Model Predicts Risk for Progression of RA-ILD
The risk for progression of rheumatoid arthritis–associated interstitial lung disease (RA-ILD) was higher in patients with a usual interstitial pneumonia (UIP) pattern, an ILD extent of > 10%, and a lower diffusing capacity for carbon monoxide (DLCO), along with elevated levels of certain biomarkers. A prediction modelbased on these clinical factors and biomarkers effectively stratified patients by their risk for disease progression.
METHODOLOGY:
Researchers analyzed data from a prospective cohort study to identify clinical risk factors for the progression of RA-ILD, as defined by the recent progressive pulmonary fibrosis (PPF) criteria, and to develop a corresponding prediction model.
They enrolled 138 adult patients diagnosed with RA-ILD (mean age, 66.4 years; 30.4% men) between January 2015 and July 2018.
Patients were followed up annually for 3 years to determine disease progression, defined as meeting the PPF criteria for both pulmonary physiology and radiographical worsening domains, assessed using pulmonary function tests and CT scans, respectively.
RA disease activity was assessed, and information on prescription medications and demographics was collected at each visit.
Levels of autoantibodies (anti–cyclic citrullinated peptide [anti-CCP] and anti–citrullinated enolase peptide) , pulmonary damage biomarkers ( Krebs von den Lungen 6 [KL-6], matrix metallopeptidase 7, and human surfactant protein D [hSP-D]), and certain inflammatory markers were evaluated.
TAKEAWAY:
Over a median follow-up period of 2.9 years, the progression of RA-ILD occurred in 35% of patients; a higher risk for progression was noted in patients with low and moderate disease activity scores than in those in remission.
An increased risk for progression was noted in patients with a definitive or probable UIP pattern (adjusted hazard ratio [aHR], 2.72; P = .004) and an ILD extent of > 10% (aHR, 3.51; P < .001). Further, a lower DLCO was associated with a higher risk for progression (aHR, 0.67 per SD; P = .01).
= .004) and an ILD extent of > 10% (aHR, 3.51; < .001). Further, a lower DLCO was associated with a higher risk for progression (aHR, 0.67 per SD; = .01). The key biomarkers predicting a higher risk for progression were higher levels of anti-CCP (aHR, 1.33 per unit), KL-6 (aHR, 1.41 per SD), and hSP-D (aHR, 1.51 per SD; P < .05 for all).
< .05 for all). The prediction model incorporating clinical factors and KL-6 level achieved an area under the curve of 0.75, with the high-risk group showing a positive predictive value of 85.7% and the low-risk group showing a negative prediction value of 94.7% for progression.
IN PRACTICE:
'The implementation of this model may facilitate the timely initiation of appropriate treatment by shortening the time required to fulfill the PPF criteria,' the authors wrote.
SOURCE:
This study was led by Sung Hae Chang, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea. It was published online on April 17, 2025, in Seminars in Arthritis & Rheumatism .
LIMITATIONS:
This study cohort primarily consisted of patients with mild ILD and was limited to a Korean population, potentially limiting generalizability. Factors such as pulmonary symptoms and oxygen saturation were not evaluated. The sample size was relatively small, and this study lacked an external validation cohort.
DISCLOSURES:
Some authors were supported by various sources, including the National Research Foundation of Korea, Rheumatology Research Foundation Scientist Development Award, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and several others. One author received support from the Soonchunhyang University Research Fund. Another author reported receiving support from and performing consultancy for several pharmaceutical companies.
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