Predictive factors for the recurrence of anti-aminoacyl-tRNA synthetase antibody-associated interstitial lung disease |
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| Affiliation: | 1. Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy;2. Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain;3. Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy;4. Rheumatology Department, Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain;5. Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain;6. UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara, Ferrara, Italy;7. Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, University of Bari, Bari, Italy;8. Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain;9. Clinic of Rheumatology, Department of Medical and Biological Sciences (DSMB), Santa Maria della Misericordia Hospital, Udine, Italy;10. Systemic Autoimmune Diseases Unit, Hospital Clínico San Cecilio, Granada, Spain;11. Department for Rheumatology and Clinical Immunology, St. Josef Krankenhaus, University Clinic, Essen, Germany;12. Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foudation, Pavia, Italy;13. ACURA Rheumatology Center, Bad Kreuznach, Germany;14. Department of Rheumatology, University Hospital Ramón y Cajal, Madrid, Spain;15. Rheumatology Unit, Santa Chiara Hospital, Trento, Italy;p. Rheumatology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy;q. Department of Internal Medicine, Rheumatology and Clinical Immunology, University Hospital Johannes-Gutenberg, Mainz, Germany;r. Division of Rheumatology, Mauriziano Hospital, Turin, Italy;s. Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milano, Italy;t. Tulane University Lung Center Tulane/UMC Scleroderma and Sarcoidosis Patient Care and Research Center New Orleans, New Orleans, LA, USA;u. Rheumatology Department, Città Della Salute e della Scienza, Torino, Italy;v. Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Reggio Emilia, Italy;w. Rheumatology Unit, University and AO Spedali Civili, Brescia, Italy;x. Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy |
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| Abstract: | BackgroundAnti-synthetase syndrome (ASS) is characterized by the presence of anti-aminoacyl-tRNA synthetase antibody and ASS-associated interstitial lung disease (ILD) often recurs. The effectiveness of remission induction therapy with corticosteroids and calcineurin inhibitor (CNI) and the predictive factors for ASS-ILD recurrence were examined.MethodsWe retrospectively identified consecutive patients with ASS-ILD treated with corticosteroids and CNI during 2006–2017 and evaluated the predictive factors for recurrence using logistic regression analysis.ResultsOf the 57 patients included in this study, 54 (94.7%) exhibited improved response to remission induction therapy. There were 32 recurrence patients during maintenance therapy. The median period until recurrence was 27 months. There were no significant differences in the baseline characteristics between the recurrence and nonrecurrence groups. In the recurrence group, respiratory function and St. George's Respiratory Questionnaire score deteriorated over the clinical course. The Krebs von den Lungen-6 (KL-6) level changed with disease behavior. The multivariate analysis revealed that KL-6 increase rate from remission (odds ratio: 3.21, 95% CI: 1.17–8.86, p = 0.02) and CNI discontinuation (odds ratio: 8.09, 95% CI: 1.39–47.09, p = 0.02) were independent predictive factors for recurrence. The receiver operating characteristics analysis revealed that the optimal cut-off point of KL-6 increase rate was 2.0. The positive predictive values of the KL-6 increase rate from remission of >2.0 and CNI discontinuation were 90.0 and 88.9%, respectively. The CNI treatment duration and recurrence were not related.ConclusionsRecurrence influenced long-term deterioration. KL-6 was a serum biomarker for disease behavior and recurrence prediction. The results suggest the importance of CNI continuation. |
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| Keywords: | Anti-aminoacyl-tRNA synthetase antibody-associated interstitial lung disease Krebs von den Lungen-6 Tacrolimus Cyclosporine Recurrence ARS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" aminoacyl-tRNA synthetase ASS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" anti-synthetase syndrome CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" confidence interval CNI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" calcineurin inhibitor CS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" corticosteroid CTD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" connective tissue disease diffusing capacity of the lung for carbon monoxide DM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" dermatomyositis FVC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" forced vital capacity ILD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" interstitial lung disease IP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0140" }," $$" :[{" #name" :" text" ," _" :" interstitial pneumonia IQR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0150" }," $$" :[{" #name" :" text" ," _" :" interquartile range KL-6" },{" #name" :" keyword" ," $" :{" id" :" kwrd0160" }," $$" :[{" #name" :" text" ," _" :" Krebs von den Lungen-6 mPSL" },{" #name" :" keyword" ," $" :{" id" :" kwrd0170" }," $$" :[{" #name" :" text" ," _" :" methylprednisolone PM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0180" }," $$" :[{" #name" :" text" ," _" :" polymyositis PSL" },{" #name" :" keyword" ," $" :{" id" :" kwrd0190" }," $$" :[{" #name" :" text" ," _" :" prednisolone ROC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0200" }," $$" :[{" #name" :" text" ," _" :" receiver operating characteristic SGRQ" },{" #name" :" keyword" ," $" :{" id" :" kwrd0210" }," $$" :[{" #name" :" text" ," _" :" St. George's Respiratory Questionnaire |
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