RT Journal Article
SR Electronic
T1 Serum Biomarkers of Pulmonary Damage and Risk for Progression of Rheumatoid Arthritis–Associated Interstitial Lung Disease
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 323
OP 333
DO 10.3899/jrheum.2024-0713
VO 52
IS 4
A1 Chang, Sung Hae
A1 Park, Yong-Beom
A1 McDermott, Gregory C.
A1 Paudel, Misti L.
A1 Hayashi, Keigo
A1 Ha, You-Jung
A1 Lee, Jeong Seok
A1 Kim, Min Uk
A1 Park, Chan Ho
A1 Kim, Ji-Won
A1 Ha, Jang Woo
A1 Chung, Sang Wan
A1 Lee, Sung Won
A1 Kang, Eun Ha
A1 Lee, Yeon Ah
A1 Choe, Jung-Yoon
A1 Lee, Eun Young
A1 Sparks, Jeffrey A.
YR 2025
UL http://www.jrheum.org/content/52/4/323.abstract
AB Objective To investigate baseline and change of pulmonary damage biomarkers (serum Krebs von den Lungen 6 [KL-6], human surfactant protein D [hSP-D], and matrix metalloproteinase 7 [MMP-7]) with rheumatoid arthritis–associated interstitial lung disease (RA-ILD) progression.Methods In the Korean Rheumatoid Arthritis Interstitial Lung Disease (KORAIL) cohort, a prospective cohort, we enrolled patients with RA and ILD confirmed by chest computed tomography imaging and followed annually. ILD progression was defined as worsening in physiological and radiological domains of the 2022 American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society guideline for progressive pulmonary fibrosis (PPF). Associations between biomarkers and RA-ILD progression were analyzed using multivariable Cox regression, adjusting for potential confounders.Results We analyzed 136 patients with RA-ILD (mean age 66.5 yrs, 30% male, 60.3% with usual interstitial pneumonia pattern). During a median 3.0 years of follow-up, 47 patients (34.6%) experienced progression. Higher baseline KL-6 and hSP-D levels were associated with higher risk of ILD progression (multivariable hazard ratios [HRs] 1.37 [95% CI 1.03-1.82] and 1.51 [95% CI 1.09-2.08], respectively), whereas only the highest quartile of MMP-7 showed an increased risk (multivariable HR 2.60 [95% CI 1.07-6.33]). Increasing levels of serum KL-6 at 1 year showed the strongest association with progression (∆KL-6: multivariable HR 2.00 [95% CI 1.29-3.11]), additionally adjusting for baseline biomarker levels.Conclusion In this first prospective study to apply PPF criteria to RA-ILD, 34.6% progressed over 3 years. Higher baseline KL-6 and hSP-D were associated with progression. In follow-up, greater change in KL-6 was associated with progression. Serial measurement of pulmonary damage biomarkers may predict RA-ILD progression and may be helpful in monitoring patients and treatment decisions.