Prevalence incidence and causespecific mortality of rheumatoid arthritisassociated

Prevalence, incidence, and cause-specific mortality of rheumatoid arthritis-associated interstitial lung disease among older patients with rheumatoid arthritis: a nationwide cohort study Jeffrey Sparks, MD Brigham and Women’s Hospital Boston, MA, USA APPROVED ACR EDUCATION PARTNER. This activity is included in the ACR's Education Partner program. Independent reporting and the viewpoints expressed are those of Infomedica and its affiliates and do not represent the ACR. SUPPORTED BY AN UNRESTRICTED EDUCATIONAL SPONSORSHIP FROM

Key message • Rheumatoid arthritis-associated interstitial lung disease is a serious extra-articular manifestation. • 5% of older patients with RA may develop RA-ILD, which has a median overall survival of 3– 8 years. • This study confirmed previously identified risk factors, including gender and smoking status, and identified new ones including comorbid lung conditions and medication use. Highlights from ACR Convergence 2020 – Developed by Infomedica

Background (1) What do we already know about this topic? • Rheumatoid arthritis (RA)-associated interstitial lung disease (RA-ILD) is one of the most severe extra-articular manifestations of the disease and it is more common in older patients. 1 -3 • The burden of RA-ILD is not fully elucidated due to either small study cohorts or heterogeneity in data collection and analysis. Highlights from ACR Convergence 2020 – Developed by Infomedica

Background (2) How was this study conducted? • This study aimed to investigate prevalence, incidence, and cause-specific mortality of RA-ILD using a validated claims-based algorithm. 4 • 509, 787 RA patients were identified in Medicare, of whom 10, 306 (2. 0%) had RA-ILD at initial RA observation. • Deaths were linked to the national death index and categorized by diagnosis codes. Highlights from ACR Convergence 2020 – Developed by Infomedica

Findings What does this study add? • Among RA without ILD at baseline, 2. 6% developed RA-ILD over a median period of 3 years person (an incidence rate of 7. 14 per 1, 000 person-years). • The study confirmed previously identified risk factors for RA-ILD, including male sex and smoking. • New risk factors identified were asthma, chronic obstructive pulmonary disease (COPD), biologic or targeted DMARD use, and glucocorticoid use. • During follow-up, 38. 7% of people with RA-ILD died compared to 20. 7% of RA without ILD. • RA-ILD was strongly associated with increased respiratory mortality compared to RA without ILD, and it was also associated to high risk of death from cancer, infection, and cardiovascular disease. Highlights from ACR Convergence 2020 – Developed by Infomedica

Perspectives How does this study impact clinical practice? • Patients should be screened for RA-ILD, and their risk predicted based on comorbid lung conditions and other risk factors. • People with RA-ILD may have increased mortality due to other causes, and this requires further investigation. Highlights from ACR Convergence 2020 – Developed by Infomedica

References 1. Natalini JG, Baker JF, Singh N, et al. Autoantibody Seropositivity and Risk for Interstitial Lung Disease in a Prospective Male-predominant Rheumatoid Arthritis Cohort of U. S. Veterans Ann Am Thorac Soc 2020; doi: 10. 1513/Annals. ATS. 202006 -590 OC. 2. Bongartz T, Nannini C, Medina-Velasquez YF, et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis Rheum 2010; 62(6): 1583– 91. 3. Juge P-A, Lee JS, Lau J, et al. Methotrexate and rheumatoid arthritis associated interstitial lung disease. Eur Respir J 2020; doi: 10. 1183/13993003. 00337 -2020. 4. Kim SY, Solomon DH. Use of administrative claims data for comparative effectiveness research of rheumatoid arthritis treatments. Arthritis Res Ther 2011; 13(5): 129. Highlights from ACR Convergence 2020 – Developed by Infomedica

Related content • Sparks JA, He X, Huang J, et al. Rheumatoid Arthritis Disease Activity Predicting Incident Clinically Apparent Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Prospective Cohort Study. Arthritis Rheumatol 2019; 71(9): 1472– 82. • Wu EK, Ambrosini RD, Kottmann RM, et al. Reinterpreting Evidence of Rheumatoid Arthritis. Associated Interstitial Lung Disease to Understand Etiology. Curr Rheumatol Rev 2019; 15(4): 277– 89. • Rojas-Serrano J, Herrera-Bringas D, Pérez-Román DI, et al. Rheumatoid arthritis-related interstitial lung disease (RA-ILD): methotrexate and the severity of lung disease are associated to prognosis. Clin Rheumatol 2017; 36(7): 1493 -500. • Sparks J, Jin Y, Cho S-K, et al. Prevalence, Incidence, and Cause-Specific Mortality of Rheumatoid Arthritis-Associated Interstitial Lung Disease Among Older Patients with Rheumatoid Arthritis: A Nationwide Cohort Study. Presented at ACR Convergence 2020; abstract 0489. Highlights from ACR Convergence 2020 – Developed by Infomedica