Predicting progression of RA-ILD using anti-CCP

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Background: ILD is a frequent extra-articular manifestation of Rheumatoid Arthritis (RA) contributing to significant morbidity and mortality. Factors that predict prognosis of ILD are unclear however high levels of anti-CCP have been reported to indicate disease progression in RA-ILD. We aimed to determine whether anti-CCP was associated with RA-ILD progression. Methods: We performed a retrospective analysis of patients attending a tertiary ILD service with a diagnosis of RA. Demographic and clinical information were extracted from medical records. Progressive RA-ILD was defined as a decrease in FVC or DLCO of >10% or radiological progression on serial CT. Joint disease was defined by the presence of erosions and progression the need for biological treatment. Results: We identified 12 patients with a median follow of 60 months (IQR 31-98). The predominant radiological pattern was UIP seen in two thirds. High anti-CCP titre >340 was found in 7 patients (58%); this correlated well with need for biological treatment p 0.04 but had an inverse correlation (-0.655) with disease progression documented on serial CT p 0.04. Progressive ILD on serial PFT was identified in 4 patients however there was no apparent relationship with anti-CCP titre. Only one patient had a concordant course demonstrating both progressive lung and joint disease. Conclusion: This data suggests that the progression of RA-ILD is independent of overall disease activity and that independent monitoring of pulmonary function is required regardless of joint disease activity. High titres of anti-CCP were not useful in predicting RA-ILD progression in this cohort however treatment with biologics may have influenced this result.

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