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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  ;  Ala Woo  ;  Youngmok Park  ;  Seung Hyun Yong  ;  Su Hwan Lee  ;  Sang Hoon Lee  ;  Ah Young Leem  ;  Song Yee Kim  ;  Kyung Soo Chung  ;  Eun Young Kim  ;  Ji Ye Jung  ;  Young Ae Kang  ;  Young Sam Kim  ;  Moo Suk Park 
 THERAPEUTIC ADVANCES IN RESPIRATORY DISEASE, Vol.16 : 17534666221135314, 2022-01 
Journal Title
Issue Date
Aged ; Arthritis, Rheumatoid* / complications ; Arthritis, Rheumatoid* / drug therapy ; Cohort Studies ; Female ; Humans ; Idiopathic Pulmonary Fibrosis* ; Lung / diagnostic imaging ; Lung Diseases, Interstitial* / drug therapy ; Lung Diseases, Interstitial* / etiology ; Male ; Methotrexate / therapeutic use ; Middle Aged ; Retrospective Studies
interstitial lung disease ; methotrexate ; mortality ; pulmonary function ; rheumatoid arthritis
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Young Ae(강영애) ORCID logo https://orcid.org/0000-0002-7783-5271
Kim, Song Yee(김송이) ORCID logo https://orcid.org/0000-0001-8627-486X
Kim, Young Sam(김영삼) ORCID logo https://orcid.org/0000-0001-9656-8482
Kim, Eun Young(김은영) ORCID logo https://orcid.org/0000-0002-3281-5744
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Park, Youngmok(박영목) ORCID logo https://orcid.org/0000-0002-5669-1491
Yong, Seung Hyun(용승현)
Woo, Ala(우아라)
Lee, Sang Hoon(이상훈) ORCID logo https://orcid.org/0000-0002-7706-5318
Lee, Su Hwan(이수환) ORCID logo https://orcid.org/0000-0002-3487-2574
Leem, Ah Young(임아영) ORCID logo https://orcid.org/0000-0001-5165-3704
Jung, Kyung Soo(정경수) ORCID logo https://orcid.org/0000-0003-1604-8730
Jung, Ji Ye(정지예) ORCID logo https://orcid.org/0000-0003-1589-4142
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