Trends in Immunotherapy

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Clinical, serological and radiological findings in patients with rheumatoid arthritis from Zanzibar comparing those with and without interstitial lung disease

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https://doi.org/10.24294/ti.v7.i2.2716
Sanaa, S., Noorein, O., Faiza, J., & Clive, K. (2023). Clinical, serological and radiological findings in patients with rheumatoid arthritis from Zanzibar comparing those with and without interstitial lung disease. Trends in Immunotherapy, 7(2). https://doi.org/10.24294/ti.v7.i2.2716
Volume 7 Issue 2 (2023)

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Trends in Immunotherapy (TI)  publishes accepted manuscripts under Creative Commons Attribution 4.0 International (CC BY 4.0). Authors who submit their papers for publication by TI agree to have the CC BY 4.0 license applied to their work, and that anyone is allowed to reuse the article or part of it free of charge for any purpose, including commercial use. As long as the author and original source are properly cited, anyone may copy, redistribute, reuse, and transform the content.

Authors

  • Said Sanaa
    The State University of Zanzibar, Zanzibar 72208, Tanzania; Mnazi Mmoja Referral Hospital, Stone Town 71000, Zanzibar
  • Omar Noorein Mnazi Mmoja Referral Hospital, Stone Town 71000, Zanzibar
  • Juma Faiza Mnazi Mmoja Referral Hospital, Stone Town 71000, Zanzibar
  • Kelly Clive James Cook University Hospital, Middlesbrough TS4 3BW, UK

Objectives: To describe the prevalence, characteristics, and outcomes of patients with rheumatoid arthritis (RA) associated interstitial lung disease (ILD) in a multi‐centre cohort. Methods: We collected data from 132 patients with RA prospectively over a four‐year period. Baseline socio‐demographic characteristics (age, sex, smoking status, disease duration, time to diagnosis) were obtained. Patients were also assessed clinically to determine articular disease activity as well as to identify any respiratory involvement. Baseline chest radiographs were requested for all participants and those with findings suggestive of possible lung disease underwent high‐resolution computed tomography (HRCT) to assess whether ILD was present. All patients with confirmed ILD were given rituximab monotherapy at recommended doses. Results: From a cohort of 132 adult RA patients, four were found to have RA‐ILD on HRCT giving a prevalence of 3%. They had a mean age of 55 ± 18.5 years with three of them being female. They had long standing RA with significant delay in time to diagnosis. None of our patients were smokers but all were strongly seropositive. Non-specific interstitial pneumonia (NSIP) was diagnosed in two patients while usual interstitial pneumonia (UIP) was diagnosed in the remaining two. All patients benefitted from rituximab monotherapy as evidenced by improvement in respiratory symptoms, combined with non-progression on repeat HRCT, in tandem with clinical disease activity scores. Conclusion: Although our patient numbers were small, our paper describes epidemiological differences in RA‐ILD for our patients when compared with patients in the West. Rituximab showed promising results in our patients, but results must clearly be interpreted with caution.

Keywords:

rheumatoid arthritis interstitial lung disease usual interstitial pneumonia non‐specific interstitial pneumonia

References

  1. Kadura S, Raghu G. Rheumatoid arthritis-interstitial lung disease: manifestations and current concepts in pathogenesis and management. European Respiratory Review 2021; 30(160): 210011. doi: 10.1183/16000617.0011-2021
  2. Messina R, Guggino G, Benfante A, Scichilone N. interstitial lung disease in elderly rheumatoid arthritis patients. Drugs Aging 2019; 37(1): 11–18. doi: 10.1007/s40266-019-00727-z
  3. Marigliano B, Soriano A, Margiotta D, et al. Lung involvement in connective tissue diseases: A comprehensive review and a focus on rheumatoid arthritis. Autoimmunity Reviews 2013; 12(11): 1076–1084. doi: 10.1016/j.autrev.2013.05.001
  4. Bongartz T, Nannini C, Medina-Velasquez YF et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: A population-based study. Arthritis Rheumatism 2010; 62(6): 1583–1591. doi: 10.1002/art.27405
  5. Ghammo H, Mitha M, Connolly C, Nyamande K. Rheumatoid arthritis associated interstitial lung disease in KwaZulu-Natal, South Africa: A retrospective 5-year review. International Journal of Respiratory and Pulmonary Medicine 2020; 7(2): 132. doi: 10.23937/2378-3516/1410132
  6. Olaosebikan H, Adeyeye O, Akintayo R, et al. Connective tissue disease-associated interstitial lung disease: An underreported cause of interstitial lung disease in Sub-Saharan Africa. Clinical Rheumatology 2021; 40(9): 3455–3460. doi: 10.1007/s10067-020-05336-5
  7. Adelowo O, Mody GM, Tikly M, et al. Rheumatic diseases in Africa. Nature Reviews Rheumatology 2021; 17(6): 363–374. doi: 10.1038/s41584-021-00603-4
  8. Bendstrup E, Møller J, Kronborg-White S, et al. interstitial lung disease in rheumatoid arthritis remains a challenge for clinicians. Journal of Clinical Medicine 2019; 8(12): 2038. doi: 10.3390/jcm8122038
  9. Gabbay E, Tarala R, Will R, et al. Interstitial lung disease in recent onset rheumatoid arthritis. American Journal of Respiratory and Critical Care Medicine 1997; 156(2): 528–535. doi: 10.1164/ajrccm.156.2.9609016
  10. Sihvonen S, Korpela M, Laippala P, et al. Death rates and causes of death in patients with rheumatoid arthritis: A population‐based study. Scandinavian Journal of Rheumatology 2004; 33(4): 221-227. doi: 10.1080/03009740410005845
  11. Zamora-Legoff JA, Krause ML, Crowson CS, et al. Progressive decline of lung function in rheumatoid arthritis-associated interstitial lung disease. Arthritis & Rheumatology 2017; 69(3): 542–549. doi: 10.1002/art.39971
  12. Fazeli MS, Khaychuk V, Wittstock K, et al. Rheumatoid arthritis-associated interstitial lung disease: Epidemiology, risk/prognostic factors, and treatment landscape. Clinical and Experimental Rheumatology 2021; 39(5): 1108–1118. doi: 10.55563/clinexprheumatol/h9tc57
  13. Kelly CA, Saravanan V, Nisar M, et al. Rheumatoid arthritis-related interstitial lung disease: associations, prognostic factors and physiological and radiological characteristics—A large multicentre UK study. Rheumatology 2014; 53(9): 1676–1682. doi: 10.1093/rheumatology/keu165
  14. Juge PA, Borie R, Kannengiesser C, et al. Shared genetic predisposition in rheumatoid arthritis-interstitial lung disease and familial pulmonary fibrosis. European Respiratory Journal 2017; 49(5): 1602314. doi: 10.1183/13993003.02314-2016
  15. Juge AP, Lee JS, Ebstein E, et al. MUC5B promoter variant and rheumatoid arthritis with interstitial lung disease. New England Journal of Medicine 2018; 379(23): 2209–2219. doi: 10.1056/nejmoa1801562
  16. Cassone G, Manfredi A, Vacchi C, et al. Treatment of rheumatoid arthritis-associated interstitial lung disease: Lights and shadows. Journal of Clinical Medicine 2020; 9(4): 1082. doi: 10.3390/jcm9041082
  17. England BR, Hershberger D. Management issues in rheumatoid arthritis-associated interstitial lung disease. Current Opinion in Rheumatology 2020; 32(3): 255–263. doi: 10.1097/bor.0000000000000703
  18. Kelly CA, Emery P, Dieude P. Current issues in rheumatoid arthritis-associated interstitial lung disease. The Lancet Rheumatology 2021; 3(11): e798–e807. doi: 10.1016/S2665-9913(21)00250-2
  19. Fui A, Bergantini L, Selvi E, et al. Rituximab therapy in interstitial lung disease associated with rheumatoid arthritis. Internal Medicine Journal 2020; 50(3): 330–336. doi: 10.1111/imj.14306
  20. Vadillo C, Nieto MA, Romero-Bueno F, et al. Efficacy of rituximab in slowing down progression of rheumatoid arthritis-related interstitial lung disease: Data from the NEREA Registry. Rheumatology 2020; 59(8): 2099–2108. doi: 10.1093/rheumatology/kez673
  21. Kim EJ, Collard HR, King TE. Rheumatoid arthritis-associated interstitial lung disease: The relevance of histopathologic and radiographic pattern. Chest 2009; 136(5): 1397–1405. doi: 10.1378/chest.09-0444
  22. Mena-Vázquez N, Jimenez-Núñez FG, Godoy-Navarrete FJ, et al. Utility of pulmonary ultrasound to identify interstitial lung disease in patients with rheumatoid arthritis. Clinical Rheumatology 2021; 40(6): 2377–2385. doi: 10.1007/s10067-021-05655-1
  23. Turesson C, O'Fallon WM, Crowson CS, et al. Extra-articular disease manifestations in rheumatoid arthritis: Incidence trends and risk factors over 46 years. Annals of the Rheumatic Diseases 2003; 62(8): 722–727. doi: 10.1136/ard.62.8.722
  24. Olson AL, Swigris JJ, Sprunger DB, et al. Rheumatoid arthritis-interstitial lung disease-associated mortality. American Journal of Respiratory and Critical Care Medicine 2011; 183(3): 372–378. doi: 10.1164/rccm.201004-0622OC
  25. Hyldgaard C, Ellingsen T, Hilberg O, Bendstrup E. Rheumatoid arthritis-associated interstitial lung disease: Clinical characteristics and predictors of mortality. Respiration 2019; 98(5): 455–460. doi: 10.1159/000502551
  26. Qiu M, Jiang J, Nian X, et al. Factors associated with mortality in rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis. Respiratory Research 2021; 22(1): 264. doi: 10.1186/s12931-021-01856-z
  27. Assayag D, Lubin M, Lee JS, et al. Predictors of mortality in rheumatoid arthritis-related interstitial lung disease. Respirology 2014; 19(4): 493–500. doi: 10.1111/resp.12234
  28. Mogire RM, Mutua A, Kimita W, et al. Prevalence of vitamin D deficiency in Africa: A systematic review and meta-analysis. The Lancet Global Health 2020; 8(1): e134–e142. doi: 10.1016/S2214-109X(19)30457-7
  29. Charoenngam N. Vitamin D and rheumatic diseases: A review of clinical evidence. International Journal of Molecular Sciences 2021; 22(19): 10659. doi: 10.3390/ijms221910659
  30. Correia CS, Briones MR, Guo R, Ostrowski RA. Elevated anti-cyclic citrullinated peptide antibody titer is associated with increased risk for interstitial lung disease. Clinical Rheumatology 2019; 38(4): 1201–1206. doi: 10.1007/s10067-018-04421-0
  31. Xie S, Li S, Chen B, et al. Serum anti-citrullinated protein antibodies and rheumatoid factor increase the risk of rheumatoid arthritis-related interstitial lung disease: A meta-analysis. Clinical Rheumatology 2021; 40(11): 4533–4543. doi: 10.1007/s10067-021-05808-2
  32. Palomäki A, Palotie A, Koskela J, et al. Lifetime risk of rheumatoid arthritis-associated interstitial lung disease in MUC5B mutation carriers. Annals of the Rheumatic Diseases 2021; 80(12): 1530–1536. doi: 10.1136/annrheumdis-2021-220698
  33. Wheeler AM, Baker JF, Poole JA, et al. Genetic, social, and environmental risk factors in rheumatoid arthritis-associated interstitial lung disease. Seminars in Arthritis and Rheumatism 2022; 57: 152098. doi: 10.1016/j.semarthrit.2022.152098
  34. Jacob J, Hirani N, van Moorsel CHM, et al. Predicting outcomes in rheumatoid arthritis related interstitial lung disease. European Respiratory Journal 2019; 53: 1800869. doi: 10.1183/13993003.00869-2018
  35. Chen J, Doyle TJ, Liu Y, et al. Biomarkers of rheumatoid arthritis-associated interstitial lung disease. Arthritis & Rheumatology 2015; 67(1): 28–38. doi: 10.1002/art.38904
  36. Kim EJ, Elicker BM, Maldonado F, et al. Usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease. European Respiratory Journal 2010; 35(6): 1322–1328. doi: 10.1183/09031936.00092309
  37. Kiely P, Busby AD, Nikiphorou E, et al. Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts. BMJ Open 2019; 9(5): e028466. doi: 10.1136/bmjopen-2018-028466
  38. Perez-Alvarez R, Perez-de-Lis M, Diaz-Lagares C, et al. Interstitial lung disease induced or exacerbated by TNF-targeted therapies: Analysis of 122 cases. Seminars in Arthritis and Rheumatism 2011; 41(2): 256–264. doi: 10.1016/j.semarthrit.2010.11.002
  39. Roubille C, Haraoui B. Interstitial lung diseases induced or exacerbated by DMARDS and biologic agents in rheumatoid arthritis: A systematic literature review. Seminars in Arthritis and Rheumatism 2014; 43(5): 613–626. doi: 10.1016/j.semarthrit.2013.09.005
  40. Md Yusof MY, Kabia A, Darby M, et al. Effect of rituximab on the progression of rheumatoid arthritis-related interstitial lung disease: 10 years’ experience at a single centre. Rheumatology 2017; 56(8): 1348–1357. doi: 10.1093/rheumatology/kex072
  41. Fernández-Díaz C, Loricera J, Castañeda S, et al. Abatacept in patients with rheumatoid arthritis and interstitial lung disease: A national multicenter study of 63 patients. Seminars in Arthritis and Rheumatism 2018; 48(1): 22–27. doi: 10.1016/j.semarthrit.2017.12.012
  42. Tardella M, Di Carlo M, Carotti M, et al. Abatacept in rheumatoid arthritis-associated interstitial lung disease: Short-term outcomes and predictors of progression. Clinical Rheumatology 2021; 40(12): 4861–4867. doi: 10.1007/s10067-021-05854-w
  43. Flaherty KR, Wells AU, Cottin V, et al. Nintedanib in progressive fibrosing interstitial lung diseases. New England Journal of Medicine 2019; 381(18): 1718–1727. doi: 10.1056/nejmoa1908681
  44. Tardella M, Di Carlo M, Carotti M, et al. A retrospective study of the efficacy of JAK inhibitors or abatacept on rheumatoid arthritis-interstitial lung disease. Inflammopharmacology 2022; 30(3): 705–712. doi: 10.1007/s10787-022-00936-w
  45. Vacchi C, Manfredi A, Cassone G, et al. Tofacitinib for the treatment of severe interstitial lung disease related to rheumatoid arthritis. Case Reports in Medicine 2021; 2021: 6652845. doi: 10.1155/2021/6652845