Radiological extent predicts prognosis and relapse after acute exacerbation of interstitial lung disease in patients with rheumatoid arthritis: KEIO-RA-cohort.

Abstract

To clarify how the extent of radiological interstitial lung abnormalities impacts the prognosis and risk of relapse in patients with rheumatoid arthritis (RA) following acute exacerbation of interstitial lung disease (AE-ILD). We conducted a retrospective review of all consecutive RA patients from the KEIO-RA cohort who experienced AE-ILD during 2012 to 2024. We investigated the association between the extent of abnormalities on high-resolution computed tomography (HRCT) images, as assessed by Goh's criteria, and outcomes in patients who survived AE-ILD versus those who did not, as well as between patients who survived AE-ILD without relapse and those who experienced relapse. Out of the 34 cases, 10 (29.4%) patients died due to AE-ILD. Of the 26 cases who survived the first AE-ILD event, 8 (30.8%) experienced a relapse, and 2 of them died. Non-survivors had higher Goh's HRCT scores both before and at the time of AE-ILD compared to survivors. Patients who experienced relapse had higher HRCT scores after AE-ILD compared to those who did not relapse. There were no significant differences in treatment regimens for AE-ILD, titers for anti-cyclic citrullinated peptide antibody or rheumatoid factor, or arthritis activity among the groups. Higher HRCT scores both before and at the time of AE-ILD are associated with increased mortality risk, while elevated scores after AE-ILD are linked to a higher likelihood of relapse. These findings highlight the critical role of HRCT assessment in guiding prognosis and post-AE-ILD management in patients with RA.