Resumen de Development of a risk indicator score for the identification of interstitial lung disease in patients with rheumatoid arthritis

Francisco Paulin, Tracy J. Doyle, Juan Francisco Mercado, Leandro Alberto Fassola, Martín Eduardo Fernández, Fabian Caro, María Laura Alberti, María Elena Crespo Espíndola, Emilio Buschiazzo

• español

  Introducción La enfermedad pulmonar intersticial (EPI) clínicamente evidente afecta al 10-42% de los pacientes con Artritis Reumatoidea (AR), con impacto en el pronóstico. El objetivo de este estudio fue identificar factores asociados y desarrollar una regla para estratificar el riesgo de EPI en pacientes con AR.

  Métodos Estudio de casos y controles. Se incluyeron pacientes con AR de una clínica de enfermedades intersticiales y un servicio de reumatología. Se consignaron datos demográficos, manifestaciones extraarticulares, scores de actividad de la enfermedad, autoanticuerpos, tratamiento. Se analizó con regresión logística multivariada.

  Resultados Se incluyeron 118 pacientes con AR, 52 (44%) con EPI (casos) y 66 (56%) sin EPI (controles). Veintiséis (22%) hombres, media de edad 56 ± 15.6 años. Cinco variables se asociaron significativamente con la presencia de EPI: género masculino, tabaquismo, manifestaciones extraarticulares, CDAI > 28, y eritrosedimentación > 80 mm/h. El área bajo la curva del modelo final fue 0.86 (IC 95% 0.79-0.92). Se escogieron dos potenciales puntos de corte del score: 2 puntos con una sensibilidad del 90.38% y una especificidad del 63.64%, y 4 puntos con una sensibilidad del 51.9% y una especificidad del 90.9%.

  Conclusión Nuestro estudio identificó variables que podrían ayudar a identificar que pacientes con AR se encuentran en riesgo de presentar EPI.

• English

  Background Clinically evident interstitial lung disease (ILD) affects 10%–42% of RA patients with prognostic implications. The aim of this study was to discern which factors are associated with the presence of ILD in RA patients and to develop a score that could help to stratify the risk of having ILD in RA patients.

  Methods Case–control study. We included RA patients recruited from ILD and rheumatology clinics. We retrieved the following data: gender, age, presence of extra articular manifestations, disease activity scores, antibodies status, ESR, and medication use. Multivariate logistic regression was performed. A risk indicator score was developed.

  Results Of 118 patients included in this study, 52 (44%) had RA-ILD (cases) and 66 (56%) had RA without ILD (controls). Twenty-six patients were male (22%), the mean age was 56.6 ± 15.6 years. Five variables were significantly associated with the presence of ILD: male gender, smoking, extraarticular manifestations, a CDAI score > 28, and ESR > 80 mm/h. The AUC of the final model curve was 0.86 (95%CI 0.79–0.92). Two potential cut-off points of the risk indicator score were chosen: a value of 2 points showed a sensitivity of 90.38% and a specificity of 63.64%, while a value of 4 points showed a sensitivity of 51.9% and a specificity of 90.9%.

  Conclusion This study identified risk factors that could help identify which RA patients are at risk of having ILD through the development of a risk indicator score. This score needs to be validated in an independent cohort.