Mortality in patients with rheumatoid arthritisassociated interstitial lung disease treated with an anti-tumor necrosis factor agent
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Background/Aims: To evaluate the impact on mortality of anti-tumor necrosisfactor (anti-TNF) treatment of rheumatoid arthritis-associated interstitial lungdisease (RA-ILD). Methods: We retrospectively reviewed the medical records of 100 RA-ILD patientswho visited our tertiary care medical center between 2004 and 2011, identifiedthose treated with an anti-TNF agent, divided patients into non-survivor and survivorgroups and evaluated their clinical characteristics and causes of death. Results: A total of 24 RA-ILD patients received anti-TNF therapy, of whom sixdied (25%). Mean age at initiation of anti-TNF therapy was significantly higher inthe nonsurvivor versus survivor group (76 years [range, 66 to 85] vs. 64 years [range,50 to 81], respectively; p = 0.043). The mean duration of anti-TNF treatment in thenon-survivor group was shorter (7 months [range, 2 to 14] vs. 23 months [range, 2to 58], respectively; p = 0.030). The duration of anti-TNF therapy in all nonsurvivingpatients was < 12 months. Pulmonary function test results at ILD diagnosis,and cumulative doses of disease-modifying drugs and steroids, did not differ betweengroups. Five of the six deaths (83%) were related to lung disease, includingtwo diffuse alveolar hemorrhages, two cases of acute exacerbation of ILD, and oneof pneumonia. The sixth patient died of septic shock following septic arthritis ofthe knee. Conclusions: Lung complications can occur within months of initial anti-TNFtreatment in older RA-ILD patients; therefore, anti-TNF therapy should be usedwith caution in these patients.
Abstract
Background/Aims: To evaluate the impact on mortality of anti-tumor necrosisfactor (anti-TNF) treatment of rheumatoid arthritis-associated interstitial lungdisease (RA-ILD). Methods: We retrospectively reviewed the medical records of 100 RA-ILD patientswho visited our tertiary care medical center between 2004 and 2011, identifiedthose treated with an anti-TNF agent, divided patients into non-survivor and survivorgroups and evaluated their clinical characteristics and causes of death. Results: A total of 24 RA-ILD patients received anti-TNF therapy, of whom sixdied (25%). Mean age at initiation of anti-TNF therapy was significantly higher inthe nonsurvivor versus survivor group (76 years [range, 66 to 85] vs. 64 years [range,50 to 81], respectively; p = 0.043). The mean duration of anti-TNF treatment in thenon-survivor group was shorter (7 months [range, 2 to 14] vs. 23 months [range, 2to 58], respectively; p = 0.030). The duration of anti-TNF therapy in all nonsurvivingpatients was < 12 months. Pulmonary function test results at ILD diagnosis,and cumulative doses of disease-modifying drugs and steroids, did not differ betweengroups. Five of the six deaths (83%) were related to lung disease, includingtwo diffuse alveolar hemorrhages, two cases of acute exacerbation of ILD, and oneof pneumonia. The sixth patient died of septic shock following septic arthritis ofthe knee. Conclusions: Lung complications can occur within months of initial anti-TNFtreatment in older RA-ILD patients; therefore, anti-TNF therapy should be usedwith caution in these patients.
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