Clinical Analysis Of 94 Patients With Rheumatoid Arthritis Complicated With Interstitial Lung Disease

OBJECTIVE: To explore the clinical characteristics of patients with rheumatoid arthritis(RA)complicated with interstitial lung disease(ILD),and hope to provide a reference for the diagnosis and treatment of RA-ILD.METHODS: This is a retrospective analysis of 94 patients with rheumatoid arthritis complicated with interstitial lung disease who were hospitalized at the First Affiliated Hospital of Guangxi Medical University from2006 to 2016 as an observation group.The rheumatoid arthritis patients who were hospitalized without interstitial lung disease were randomly selected as a control group.Analyze the clinical characteristics and risk factors of rheumatoid arthritis patients with interstitial lung disease,and analyze the characteristics,the relationship with clinical data,and treatment outcome of chest high-resolution computed tomography(HRCT)with RA-ILD.RESULTS:1.Of the 94 patients with RA-ILD,34(36.17%)males and 60(63.83%)females had the mean age of 59.00 ± 11.76 years.The duration of the disease was from 1 month to 37 years,while the average duration was 7.66 ± 7.58 years.Of the 94 RA patients without ILD,18(19.15%)males and 76(80.85%)femaleswere enrolled in the study.The duration of disease was from 1 month to 35 years,with an average duration of 7.66.73 years.The ratio of male to female and age in RA-ILD group was higher than that in control group(P <0.05).2.The incidence of respiratory symptoms and signs,cough,expectoration,exertional dyspnea,Velcro rales in pulmonary auscultation in the RA-ILD group was significantly higher than that in the RA group(P <0.05).The white blood cell count,eosinophil count,hemoglobin,globulin,CEA,CA-125,CA-153,CA-199,C3,C4,IgG,,IgA,IgM,anti-CCP antibody level and the positive rate of anti-CCP antibody of RA-ILD patients was higher than that of RA without ILD(P <0.05).3.Logistic regression analysis showed that male,complement C4 levels,and immunoglobulin A levels were independent risk factors for RA-ILD,with whether or not with ILD as a dependent variable.4.The most common CT characteristics in RA-ILD patients was ground-glass opacity(65.33%),followed by the cable shadow(58.67%),pleura incrassation(41.33%),bullae of lung(25.33%),Small nodules(20.00%),reticular pattern(18.67%)and so on.In the six lung areas,the CT scores in the left or right lower lung areas were higher than those in the left or right middle lung areas,and the CT scores of the left or right middle lung areas were higher than those of the left or right upper lung areas(P <0.05).There was no significant difference between the CT scores of all the left and right lung areas(P> 0.05).5.In RA-ILD patients,CT scores of ILD of the patients with exertional dyspnea were higher than those without exertional dyspnea,and were lower in patients with a history of methotrexate or leflunomide than patients without the history(P <0.05).The CT score of ILD was positively correlated with level ofLDH,CEA,CA-125,CA-153(P <0.05).6.Multiple linear regression with CT score of RA-ILD patients as the dependent variable showed that exertional dyspnea,MTX medication history,morning stiffness are independent factors,exertional dyspnea as a risk factor,while MTX medication history and morning stiffness as protective factors.7.Treated with glucocorticoid + immunosuppressive agents,glucocorticoid+ methotrexate and / or leflunomide,glucocorticoid + methotrexate +leflunomide,all of the follow-up CT score of RA-ILD patients is lower than before(P <0.05).Follow-up CT scores treated with glucocorticoid +immunosuppressive agents showed a effective rate of 61.29% with 2 parients deteriorated;Follow-up CT scores treated with glucocorticoid+ methotrexate and / or leflunomide showed a effective rate of 71.43% and with no deterioration;Follow-up CT scores treated with glucocorticoid+ methotrexate and / or leflunomide showed a effective rate of 66.67% and with no deterioration.4 RA-ILD patients with a history of methotrexate and / or leflunomide were treated with the original drug(methotrexate and / or leflunomide).Follow-up CT Scores showed that 1 patient was unchanged,the remaining 3 patients were reduced,however,there was no significant difference between follow-up and before(P> 0.05).CONCLUSION:1.Male,elevated level of C4 and IgA were independent risk factors for RA-ILD.2.Lower lung areas of RA-ILD may be the most serious involvement,followed by the middle lung areas,then the upper lung areas,there was no significant difference in involvement between left and right lung areas.3.Compared with RA group,CEA,CA125,CA153 level in RA-ILD patients was higher,and was positively correlated with CT scores of ILD in RA-ILD patients.4.Exertional dyspnea was the independent risk factor for ILD CT scores,while MTX medication history and morning stiffness for its independent protective factors.5.glucocorticoid + immunosuppressive agents,including glucocorticoid +methotrexate and / or leflunomide,may be used to treat patients with RA-ILD.