Document Detail

Rheumatoid arthritis treatment and the risk of severe interstitial lung disease.
MedLine Citation:
PMID:  17657669     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Interstitial lung disease (ILD) is an important complication of rheumatoid arthritis (RA) or its treatment, and is associated with substantially increased mortality. Reports have suggested that infliximab with or without azathioprine might lead to rapidly progressive or fatal ILD. We used an RA data bank to assess the associations of treatments for RA and severe ILD. METHODS: ILD was identified in hospitalisations and death records in 100 of 17,598 RA patients and studied in relation to RA therapy with Cox regression analyses. RESULTS: The incidence of hospitalisation for ILD (HILD) was 260 per 100,000 patient years. Among those hospitalised for ILD, 27.0% died. In multivariable models of current and past RA treatment, the only current treatment associated with HILD was prednisone: hazard ratio (HR) 2.5 [95% confidence interval (CI) 1.5-4.1]. Among past therapies, prednisone (HR 3.0, 95% CI 1.0-8.9), infliximab (HR 2.1, 95% CI 1.1-3.8), etanercept (HR 1.7, 95% CI 1.0-3.0), and cyclophosphamide (HR 3.7, 95% CI 0.9-15.5) were associated with HILD. Pre-existing lung problems were identified in 67% of HILD. Only one case of HILD in the 100 hospitalisations suggested a possible temporal relationship between infliximab and HILD. CONCLUSIONS: Associations between RA treatment and HILD are confounded by the prescription of treatments for ILD such as prednisone, infliximab, etanercept, and cyclophosphamide. There is no clear pattern of causal association of treatment and ILD, and there is no clear evidence to support a causal relationship between infliximab, azathioprine, and HILD.
F Wolfe; L Caplan; K Michaud
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Scandinavian journal of rheumatology     Volume:  36     ISSN:  0300-9742     ISO Abbreviation:  Scand. J. Rheumatol.     Publication Date:    2007 May-Jun
Date Detail:
Created Date:  2007-07-27     Completed Date:  2007-08-09     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  0321213     Medline TA:  Scand J Rheumatol     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  172-8     Citation Subset:  IM    
National Data Bank for Rheumatic Diseases, Arthritis Research Center Foundation, Wichita, KS 67214, USA.
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MeSH Terms
Antibodies, Monoclonal / adverse effects
Arthritis, Rheumatoid / complications,  drug therapy*
Lung Diseases, Interstitial / etiology*
Methotrexate / adverse effects
Middle Aged
Grant Support
5 T32 AR 07279-27/AR/NIAMS NIH HHS
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/infliximab; 59-05-2/Methotrexate

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