PT - JOURNAL ARTICLE AU - Vanessa L. Kronzer AU - Weixing Huang AU - Paul F. Dellaripa AU - Sicong Huang AU - Vivi Feathers AU - Bing Lu AU - Christine K. Iannaccone AU - Ritu R. Gill AU - Hiroto Hatabu AU - Mizuki Nishino AU - Cynthia S. Crowson AU - John M. Davis III AU - Michael E. Weinblatt AU - Nancy A. Shadick AU - Tracy J. Doyle AU - Jeffrey A. Sparks TI - Lifestyle and Clinical Risk Factors for Incident Rheumatoid Arthritis-associated Interstitial Lung Disease AID - 10.3899/jrheum.200863 DP - 2020 Nov 15 TA - The Journal of Rheumatology PG - jrheum.200863 4099 - http://www.jrheum.org/content/early/2021/01/12/jrheum.200863.short 4100 - http://www.jrheum.org/content/early/2021/01/12/jrheum.200863.full AB - Objective To determine the association between novel lifestyle factors on risk of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD), define the threshold at which smoking increases RA-ILD risk, and calculate the degree to which known lifestyle and clinical factors predict RA-ILD. Methods This nested case-control study matched incident RA-ILD cases to RA non-ILD controls on age, sex, RA duration, rheumatoid factor, and time from exposure assessment to RA-ILD. Exposures included education, BMI, smoking, anticyclic citrullinated peptide antibodies, race, joint erosions, rheumatoid nodules, C-reactive protein (CRP), disease activity score, functional status, disease-modifying antirheumatic drug use, and glucocorticoid use. OR for each exposure on risk of RA-ILD were obtained from logistic regression models. Area under the curve (AUC) was calculated based on all lifestyle and clinical exposures. Results We identified 84 incident RA-ILD cases and 233 matched controls. After adjustment, obesity, high-positive CRP (≥ 10 mg/L), and poor functional status (multidimensional Health Assessment Questionnaire [MDHAQ] ≥ 1) were associated with increased risk of RA-ILD (OR 2.42, 95% CI 1.11–5.24 vs normal BMI; OR 2.61, 95% CI 1.21–5.64 vs CRP < 3 mg/L; OR 3.10, 95% CI 1.32–7.26 vs MDHAQ < 0.2). Smoking 30 pack-years or more was strongly associated with risk of RA-ILD compared to never smokers (OR 6.06, 95% CI 2.72–13.5). Together, lifestyle and clinical risk factors for RA-ILD had an AUC of 0.79 (95% CI 0.73–0.85). Conclusion Obesity, CRP, functional status, and extensive smoking may be novel risk factors for RA-ILD that may be useful for RA-ILD risk assessment and prevention. The overall ability to predict RA-ILD remains modest.