Sex, Age Differences Affect Interstitial Lung Disease Subtypes in Rheumatoid Arthritis

Older age, seropositivity, and male sex were key risk factors for rheumatoid arthritis-associated usual interstitial pneumonia (RA-UIP), while RA-related autoantibodies were more closely tied to rheumatoid arthritis-associated nonspecific interstitial pneumonia (RA-NSIP), according to a recent publication in Arthritis Care & Research.

The investigators analyzed demographic, serologic, and lifestyle risk factors associated with various RA-ILD subtypes, particularly usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP).

Researchers systematically identified RA-ILD cases and RA-noILD controls from 2 cohorts: the Brigham RA Sequential Study and the Mass General Brigham Biobank RA cohort. Subtypes of RA-ILD were determined using high-resolution chest computed tomography (HRCT). The study used multivariable logistic regression to analyze associations between risk factors and major RA-ILD subtypes.

Out of 3328 RA patients, 208 were diagnosed with RA-ILD and 547 served as controls. RA-UIP was significantly associated with older age (odds ratio [OR] 1.03 per year), male sex (OR 2.15), and seropositivity (OR 2.08). RA-NSIP was mainly associated with seropositivity (OR 3.21). Additionally, non-fibrotic ILD subtypes showed a strong association with smoking (OR 2.81). The combination of being male, seropositive, and a smoker increased the risk of developing RA-UIP (OR 6.89).

These findings underscore the importance of considering RA-ILD subtypes when assessing patient risk and suggest that sex differences in RA-ILD may be driven primarily by RA-UIP. Further research is necessary to better understand the heterogeneity of RA-ILD and to improve screening and treatment strategies.

Reference
McDermott GC, Hayashi K, Juge PA, et al. Impact of sex, serostatus, and smoking on risk for rheumatoid arthritis-associated interstitial lung disease subtypes. Arthritis Care Res (Hoboken). Published online September 11, 2024. doi:10.1002/acr.25432