FRI0039 THE LUNG IN AN ENGLISH COHORT OF RHEUMATOID ARTHRITIS PATIENTS – AN OVERVIEW OF DIFFERENT TYPES OF INVOLVEMENT AND TREATMENT. (June 2019) - Duarte, Ana Catarina
Abstract : Background: Lung disease is described in 5–20% of patients (pts) with Rheumatoid arthritis (RA) and affects parenchyma, pleura, airways and vasculature; drug-induced pulmonary disease also occurs. It is associated with a higher mortality and identification of safe and effective drugs is essential. Objectives: Characterize lung involvement in a RA cohort; evaluate rituximab (RTX) effectiveness and safety in RA associated interstitial lung disease (ILD). Methods: Retrospective analysis of the electronic records from RA cohort followed at University College Hospital. Lung involvement was based on high resolution computed tomography. Demographic data, smoking status, complementary exams at baseline/follow-up and therapies used were analysed. A sub-analysis of pts treated with rituximab (RTX) evaluated response at 12, 24 and 36 months. Declines of 15% in gas transfer from baseline and/or 10% in forced vital capacity were recognized. Results: From 1129 RA pts, 87 (7.7%) had documented lung involvement. Mean age at last follow-up was 68.3±12 years, 74.7% were female and 85.1% Caucasian. Median disease duration was 14 (IQR 8-29) years. 54% of pts had erosive disease. Rheumatoid factor was positive in 88.1% and anti-citrullinated protein antibodies in 87.8%. 23 pts had positive antinuclear antibodies (25 missing data) and 4 anti-Ro, 2 anti-Scl70 and 2 anti-PL12. Secondary Sjögren's syndrome occurred in 6.9%, cutaneous rheumatoid nodules in 5.7% and cutaneous vasculitis in 1.1%. 11.5% and 43.7% were current and previous smokers, respectively. Mean interval between onset of articular and pulmonary symptoms was 12.3 years; 2 pts had lung disease as a prior manifestation. Types of lung involvement are shown in table 1 . At last follow-up appointment 22 pts were still on methotrexate (MTX) and 27 had previously received it. MTX-acute pneumonitis occurred in 2 pts, both in the 1st year of treatment. RTX was used in 26 pts (57.8%) with ILD (14 nonspecific interstitial pneumonia-NSIP, 8 usual interstitial pneumonia-UIP, 2 organising pneumonia-OP). The mean number of cycles was 4 (range 1-12). Two pts were concomitantly receiving mycophenolate mofetil and 1 azathioprine. RTX treatment outcomes are shown in table 2 . There were 18 (20.7%) deaths, 7 of them related to ILD (4 UIP, 3 NSIP) and occurred 8.8 years after ILD diagnosis. Two were due to infection, but none was felt to be directly related to immunosuppressive therapy. Conclusion: Lung disease occurred in 7.7% of our cohort, with ILD being the commonest presentation (51.7%). MTX was widely used in pts with lung disease with only 2 cases of acute pneumonitis. Although the number of ILD pts treated with RTX was small, the drug improved/stabilized the disease in most NSIP and OP pts. UIP is usually progressive, but our data suggest that disease progression might be put on hold with RTX, at least in a subset of pts. Reference: [1] Shaw M, Collins BF, Ho LA, Raghu G. Rheumatoid arthritis-associated lung disease. Eur Respir Rev. 2015 Mar 1;24(135):1–16. Disclosure of Interests: None declared