Rheumatoid interstitial lung disease in Canterbury, Aotearoa New Zealand - A retrospective cohort study.

BACKGROUND: Rheumatoid arthritis associated interstitial lung disease (RA-ILD), is an important extra-articular manifestation of rheumatoid arthritis (RA). The frequency, risk factors, and prognosis of RA-ILD are incompletely understood. AIMS: To determine the prevalence and incidence, clinical characteristics and risk factors for development, and outcomes of persons with RA-ILD in the population of the Canterbury District Health Board (CDHB) catchment area. METHODS: Individuals aged ≥ 18 years with RA, resident in the CDHB catchment area between 1 January 2006 and 31 December 2008 (Period One), and 1 January 2011 to 31 December 2013 (Period Two) were identified by medical record review and followed until 30 June 2019. Individuals with RA-ILD as defined by pre-specified criteria were identified. The association between demographic and clinical characteristics and RA-ILD development and mortality was examined using Cox-proportional hazards models. RESULTS: The prevalence of RA-ILD per 100,000 was 10.97 (95 % CI 7.53,14.42) for Period One, and 14.74 (95 % CI 10.84,18.63) for Period Two. Among individuals evaluated for risk factors for RA-ILD development, the estimated cumulative incidence of ILD at 10 years was 4.47 % (95 % CI 3.14, 6.14). After adjusting for age, rheumatoid factor positivity (HR 3.73, 95 % CI, 1.32,10.56), extra-articular manifestations other than RA-ILD (HR 4.48, 95 % CI 2.36,8.48), and subcutaneous rheumatoid nodules (HR 4.66, 95 % CI 2.34, 9.26) were associated with increased risk of developing RA-ILD. The standardised mortality ratio for RA-ILD was 3.90 (95 % CI 2.55,5.72) compared to the general population. Extent of ILD on CT chest was associated with mortality (HR for >20% vs. < 20 % 4.47, 95 % CI 1.67,11.96). CONCLUSIONS: Clinically evident RA-ILD occurred in approximately 5 % of individuals with RA. Mortality was increased almost fourfold compared to the general population. Radiologic extent was the most important prognostic factor.

Care of patients with early inflammatory arthritis in the Wellington region according to the British Society of Rheumatology's best practice tariff standards.

AIM: To compare the care of patients with suspected early inflammatory arthritis (EIA) in the Wellington region with the quality standards from the British Society of Rheumatology (BSR) 2013/14 best practice tariffs. METHODS: The case notes for patients first seen in clinic from the beginning of 2015 were reviewed until at least 100 cases of suspected inflammatory arthritis were identified. Data gathered included the length of time from referral to first specialist rheumatology clinic, the length of time from referral to the commencement of disease modifying therapy for cases of inflammatory arthritis and the number of specialist-led clinics within the first 12 months of the first appointment. RESULTS: 117 cases of suspected inflammatory arthritis were reviewed. The median time from referral to the first appointment was 11.4 weeks (IQR 6.6-13.3). 61 of the 117 cases had clinically confirmed EIA. The median time from referral to the commencement of disease-modifying therapy was 10.5 weeks (IQR 5-15). For confirmed EIA, the median number of clinics in the first year was four (IQR 3-4). CONCLUSION: Patients with suspected inflammatory arthritis in the Wellington region wait much longer to be seen than is recommended by the BSR guidelines.