Rheumatoid arthritis, quantitative parenchymal lung features, and mortality among smokers

Gregory C McDermott; Keigo Hayashi; Kazuki Yoshida; Pierre-Antoine Juge; Matthew Moll; Michael H Cho; Tracy J Doyle; Gregory L Kinney; Paul F Dellaripa; Zachary S Wallace; Elizabeth A Regan; Gary M Hunninghake; Edwin K Silverman; Samuel Y Ash; Raul San Jose Estepar; George R Washko; Jeffrey A Sparks

doi:10.1093/rheumatology/kead645

Rheumatoid arthritis, quantitative parenchymal lung features, and mortality among smokers

Rheumatology (Oxford). 2023 Dec 4:kead645. doi: 10.1093/rheumatology/kead645. Online ahead of print.

Authors

Gregory C McDermott^{1

2}, Keigo Hayashi¹, Kazuki Yoshida^{1

2}, Pierre-Antoine Juge^{1

2

3

4}, Matthew Moll^{2

5

6

7}, Michael H Cho^{2

5

6}, Tracy J Doyle^{2

5}, Gregory L Kinney⁸, Paul F Dellaripa^{1

2}, Zachary S Wallace^{2

9}, Elizabeth A Regan¹⁰, Gary M Hunninghake^{2

5}, Edwin K Silverman^{2

5

6}, Samuel Y Ash^{2

5}, Raul San Jose Estepar^{2

5}, George R Washko^{2

5}, Jeffrey A Sparks^{1

2}

Affiliations

¹ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA.
² Harvard Medical School, Boston, MA, USA.
³ Université de Paris Cité, INSERM UMR 1152, Paris, F-75018, France.
⁴ Service de Rhumatologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, F-75018, France.
⁵ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁶ Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁷ Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Department of Medicine, VA Boston Healthcare System, West Roxbury, USA, MA.
⁸ Colorado School of Public Health, Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁹ Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Division of Rheumatology, National Jewish Health, Denver, CO, USA.

PMID: 38048611
DOI: 10.1093/rheumatology/kead645

Abstract

Objectives: There have been limited investigations of the prevalence and mortality impact of quantitative computed tomography (QCT) parenchymal lung features in rheumatoid arthritis (RA). We examined the cross-sectional prevalence and mortality associations of QCT features, comparing RA and non-RA participants.

Methods: We identified participants with and without RA in COPDGene, a multicentre cohort study of current or former smokers. Using a k-nearest neighbor quantifier, high resolution CT chest scans were scored for percentage of normal lung, interstitial changes, and emphysema. We examined associations between QCT features and RA using multivariable linear regression. After dichotomizing participants at the 75th percentile for each QCT feature among non-RA participants, we investigated mortality associations by RA/non-RA status and quartile 4 vs quartiles 1-3 of QCT features using Cox regression. We assessed for statistical interactions between RA and QCT features.

Results: We identified 82 RA cases and 8820 non-RA comparators. In multivariable linear regression, RA was associated with higher percentage of interstitial changes (β = 1.7 ± 0.5, p= 0.0008) but not emphysema (β = 1.3 ± 1.7, p= 0.44). Participants with RA and >75th percentile of emphysema had significantly higher mortality than non-RA participants (HR 5.86, 95%CI 3.75-9.13) as well as RA participants (HR 5.56, 95%CI 2.71-11.38) with ≤75th percentile of emphysema. There were statistical interactions between RA and emphysema for mortality (multiplicative p= 0.014; attributable proportion 0.53, 95%CI 0.30-0.70).

Conclusions: Using machine learning-derived QCT data in a cohort of smokers, RA was associated with higher percentage of interstitial changes. The combination of RA and emphysema conferred >5-fold higher mortality.

Keywords: emphysema; interstitial lung abnormalities; quantitative imaging; rheumatoid arthritis.

Abstract

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