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. 2022 Jan-Dec:16:17534666221135314.
doi: 10.1177/17534666221135314.

Protective effect of methotrexate on lung function and mortality in rheumatoid arthritis-related interstitial lung disease: a retrospective cohort study

Kangjoon Kim  1 , Ala Woo  1 , Youngmok Park  1 , Seung Hyun Yong  1 , Su Hwan Lee  1 , Sang Hoon Lee  1 , Ah Young Leem  1 , Song Yee Kim  1 , Kyung Soo Chung  1 , Eun Young Kim  1 , Ji Ye Jung  1 , Young Ae Kang  1 , Young Sam Kim  1 , Moo Suk Park  2
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Protective effect of methotrexate on lung function and mortality in rheumatoid arthritis-related interstitial lung disease: a retrospective cohort study

Kangjoon Kim et al. Ther Adv Respir Dis. 2022 Jan-Dec.

Abstract

Background: Studies on the risk and protective factors for lung function decline and mortality in rheumatoid arthritis-related interstitial lung disease (RA-ILD) are limited.

Objectives: We aimed to investigate clinical factors and medication uses associated with lung function decline and mortality in RA-ILD.

Methods: This retrospective cohort study examined the medical records of patients with RA-ILD who visited Severance Hospital between January 2006 and December 2019. We selected 170 patients with RA-ILD who had undergone at least one spirometry test and chest computed tomography scan. An absolute decline of ⩾10% in the functional vital capacity (FVC) was defined as significant decline in pulmonary function. Data for analysis were retrieved from electronic medical records.

Results: Ninety patients (52.9%) were female; the mean age was 64.0 ± 10.2 years. Multivariate logistic regression showed that a high erythrocyte sediment rate level at baseline [odds ratio (OR) = 3.056; 95% confidence interval (CI) = 1.183-7.890] and methotrexate (MTX) use (OR = 0.269; 95% CI = 0.094-0.769) were risk and protective factors for lung function decline, respectively. Multivariate Cox regression analysis indicated that age ⩾65 years (OR = 2.723; 95% CI = 1.142-6.491), radiologic pattern of usual interstitial pneumonia (UIP) or probable UIP (OR = 3.948; 95% CI = 1.522-10.242), baseline functional vital capacity (FVC) % predicted (OR = 0.971; 95% CI = 0.948-0.994), and MTX use (OR = 0.284; 95% CI = 0.091-0.880) were predictive of mortality.

Conclusion: We identified risk and protective factors for lung function decline and mortality in patients with RA-ILD. MTX use was associated with favorable outcome in terms of both lung function and mortality in our cohort.

Keywords: interstitial lung disease; methotrexate; mortality; pulmonary function; rheumatoid arthritis.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow chart of study enrollment. CTD, connective tissue disease; DM, dermatomyositis; HRCT, high-resolution computed tomography; ILD, interstitial lung disease; MCTD, mixed connective tissue disease; PM, polymyositis; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; SSc, systemic sclerosis.
Figure 2.
Figure 2.
Kaplan–Meier curves displaying the estimated probability of survival for the different groups of patients. MTX, methotrexate; UIP, usual interstitial pneumonia.
See this image and copyright information in PMC

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