The prevalence and risk factors of rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis
H. Wang, Yanyun Wang, Zhiyu Li, Peijie He, Shan Liu, Qiushuang Li
Abstract
Background Interstitial lung disease (ILD) is the most widespread and fatal pulmonary complication of rheumatoid arthritis (RA). Existing knowledge on the prevalence and risk factors of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is inconclusive. Therefore, we designed this review to address this gap.Materials and Methods To find relevant observational studies discussing the prevalence and/or risk factors of RA-ILD, EMBASE, Web of Science, PubMed, and the Cochrane Library were explored. The pooled odds ratios (ORs) / hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated with a fixed/ random effects model. While subgroup analysis, meta-regression analysis and sensitivity analysis were carried out to determine the sources of heterogeneity, the I2 statistic was utilized to assess between-studies heterogeneity. Funnel plots and Egger’s test were employed to assess publication bias. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, our review was conducted.Results A total of 56 studies with 11,851 RA-ILD patients were included in this meta-analysis. The pooled prevalence of RA-ILD was 18.7% (95% CI 15.8–21.6) with significant heterogeneity (I2 = 96.4%). The prevalence of RA-ILD was found to be more likely as a result of several identified factors, including male sex (ORs = 1.92 95% CI 1.70–2.16), older age (WMDs = 6.89, 95% CI 3.10–10.67), having a smoking history (ORs =1.91, 95% CI 1.48–2.47), pulmonary comorbidities predicted (HRs = 2.08, 95% CI 1.89–2.30), longer RA duration (ORs = 1.03, 95% CI 1.01–1.05), older age of RA onset (WMDs =4.46, 95% CI 0.63–8.29), positive RF (HRs = 1.15, 95%CI 0.75-1.77; ORs = 2.11, 95%CI 1.65–2.68), positive ACPA (ORs = 2.11, 95%CI 1.65–2.68), higher ESR (ORs = 1.008, 95%CI 1.002–1.014), moderate and high DAS28 (≥3.2) (ORs = 1.87, 95%CI 1.36–2.58), rheumatoid nodules (ORs = 1.87, 95% CI 1.18-2.98), LEF use (ORs = 1.42, 95%CI 1.08–1.87) and steroid use (HRs= 1.70, 1.13–2.55). The use of biological agents was a protective factor (HRs = 0.77, 95% CI 0.69–0.87).Conclusion(s) The pooled prevalence of RA-ILD in our study was approximately 18.7%. Furthermore, we identified 13 risk factors for RA-ILD, including male sex, older age, having a smoking history, pulmonary comorbidities, older age of RA onset, longer RA duration, positive RF, positive ACPA, higher ESR, moderate and high DAS28 (≥3.2), rheumatoid nodules, LEF use and steroid use. Additionally, biological agents use was a protective factor.