Parameters effective on survival in connective tissue disease-related interstitial lung disease

Yıl 2024, , 670 - 674, 27.10.2024

Siahmet Atlı , Gamze Kırkıl , Mutlu Kutluöztürk Önsel Öner , Süleyman Serdar Koca , Ayşe Murat Aydın , Sibel Doğru

https://doi.org/10.32322/jhsm.1545884

Öz

Aims: Connective tissue diseases (CTD) are systemic diseases that most commonly cause lung involvement. To examine how the disease will progress and survival at the time of diagnosis in connective tissue disease related interstitial lung disease (CTD-related ILD).
Methods: Patients with radiological diagnosis of CTD-related ILD were included in this retrospective study. Seventy-five patients aged over 18 years, who were diagnosed as having ILD radiologically and rheumatoid arthritis, Sjögren’s syndrome, polymyositis/dermatomyositis, systemic sclerosis, ankylosing spondylitis, systemic lupus erythematosus. Patients who underwent high-resolution computed tomography, pulmonary function test, carbon monoxide diffusion capacity test, and 6-minute walk test were included in the study. During the 1-year follow-up period, the data of the patients who died and survived were compared.
Results: Of the 75 patients included in the study, 55 were women and 20 were men. There were comorbidities in 56 (74.66%) patients. There was no statistical difference between the patients’ CTD subtype and FEV1, FVC, FEV1/FVC, DLCO, 6MWT distance, and 6MWT baseline oxygen saturation. At the end of the 1-year follow-up period, four patients died. Age, sex, smoking, CTD subtype, presence of comorbidities, and chronic obstructive pulmonary disease were not associated with survival, but it was determined that non CTD duration, the presence of CHF, DM, and a fibrosis rate of >10% were statistically significantly associated with survival. Among the serologic markers, ESR (60.25±17.72 vs. 24.52±18.96) and CRP (81.12±80.53 vs. 6.36±7.53) were found to be statistically significantly higher in patients who died; the levels of other markers were similar to patients who survived. FEV1, FVC, and 6MWT distances were significantly lower in patients who died. The presence of emphysema, air cysts, nodule, atelectasis, septal thickening, parenchymal bands, air trapping, honeycomb, opacity, ground-glass, mosaic attenuation, and bronchiectasis was not found to be associated with survival in HRCT. However, calcific nodules, pleural effusion, bronchial wall thickening, and fibrotic change were found to be statistically significantly associated with survival.
Conclusion: We suggest that patients with CTD-related ILD with comorbidity, low baseline respiratory function parameters, a fibrosis rate of >10% on HRCT, calcific nodule, pleural effusion, bronchial wall thickening, and fibrotic changes should be followed more closely in terms of disease progression and mortality.

Anahtar Kelimeler

Connective tissue diseases, interstitial lung diseases, survey

Etik Beyan

Ethical approval was received 17.10.2019

Destekleyen Kurum

Yok

Proje Numarası

15/01

Teşekkür

The authors are grateful to the anonymous referees for their comments that helped improve the article.

Kaynakça

• Mira Avendano I, Abril A, Burger CD, et al. Interstitial lung disease and other pulmonary manifestations in connective tissue diseases. Mayo Clinic Proceedings; Elsevier. 2019;94:309-325.
• Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2018;198(5):e44-e68.
• Langezaal LC, Welsing PM, Spierings J, et al. Prognostication of progressive pulmonary fibrosis in connective tissue disease-associated interstitial lung diseases: a cohort study. Front Med. 2023;10:1106560.
• Chiu YH, Spierings J, de Jong PA, et al. Predictors for progressive fibrosis in patients with connective tissue disease associated interstitial lung diseases. Respirat Med. 2021;187:106579.
• Tanaka Y, Kuwana M, Fujii T, et al. 2019 Diagnostic criteria for mixed connective tissue disease (MCTD): From the Japan research committee of the ministry of health, labor, and welfare for systemic autoimmune diseases. Mod Rheumatol. 2021;31(1): 29-33.
• Lundberg IE, Tjärnlund A, Bottai M, et al. EULAR/ACR classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis. 2017;76(12):1955.
• Shiboski CH, Shiboski SC, Seror R, et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren’s syndrome: a consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis. 2017;76(1):9-16.
• Van Den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013;65(11):2737-2747.
• Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-2581.
• Reiseter S, Gunnarsson R, Mogens Aaløkken T, et al. Progression and mortality of interstitial lung disease in mixed connective tissue disease: a long-term observational nationwide cohort study. Rheumatology. 2018;57(2):255-262.
• Kim D, Cho SK, Choi CB, et al. Impact of interstitial lung disease on mortality of patients with rheumatoid arthritis. Rheumatol Int. 2017;37(10):1735-1745.
• Salaffi F, Carotti M, Di Carlo M, Tardella M, Giovagnoni A. High-resolution computed tomography of the lung in patients with rheumatoid arthritis: Prevalence of interstitial lung disease involvement and determinants of abnormalities. Medicine. 2019;98(38):e17088.
• Song ST, Kim SS, Kim JY, et al. Association of single nucleotide polymorphisms of PADI4 and HLA-DRB1 alleles with susceptibility to rheumatoid arthritis-related lung diseases. Lung. 2016;194(5):745-753.
• Moore OA, Proudman SM, Goh N, et al. Quantifying change in pulmonary function as a prognostic marker in systemic sclerosis-related interstitial lung disease. Clin Exp Rheumatol. 2015;33(4 Suppl 91):S111-S116.
• Zamora-Legoff JA, Krause ML, Crowson CS, Ryu JH, Matteson EL. Patterns of interstitial lung disease and mortality in rheumatoid arthritis. Rheumatology. 2017;56(3):344-350.
• Chan C, Ryerson CJ, Dunne JV, Wilcox PG. Demographic and clinical predictors of progression and mortality in connective tissue disease-associated interstitial lung disease: a retrospective cohort study. BMC Pulm Med. 2019;19(1):1-9.
• Yunt ZX, Chung JH, Hobbs S, et al. High resolution computed tomography pattern of usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease: relationship to survival. Respir Med. 2017;126:100-104.
• Winstone TA, Assayag D, Wilcox PG, et al. Predictors of mortality and progression in scleroderma-associated interstitial lung disease: a systematic review. Chest. 2014;146(2):422-436.
• Marie I. Morbidity and mortality in adult polymyositis and dermatomyositis. Curr Rheumatol Rep. 2012;14(3):275-285.
• Chiu YH, Spierings J, de Jong PA, et al. Predictors for progressive fibrosis in patients with connective tissue disease associated interstitial lung diseases. Respir Med. 2021;187:106579.