Clinical features, management and outcome of rheumatoid arthritis patients with pulmonary involvement in intensive care unit: a retrospective observational case series study

Junhui Ba; Jingcong Zhang; Hang Jiang; Yanhong Wang; Benquan Wu

doi:10.18203/2320-6012.ijrms20252417

Authors

Junhui Ba Department of Medical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
Jingcong Zhang Department of Medical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
Hang Jiang Department of Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
Yanhong Wang Department of Medical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
Benquan Wu Department of Medical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China

DOI:

https://doi.org/10.18203/2320-6012.ijrms20252417

Keywords:

Rheumatoid arthritis, Intensive care unit, Interstitial lung disease, Outcome

Abstract

Rheumatoid arthritis (RA) is one of the rheumatic diseases with life-threatening complications that may require admission to the intensive care unit (ICU). In this study, we aimed to evaluate the clinical features, management and factors that may influence the course and prognosis of RA patients with pulmonary involvement in ICU. A retrospective observational study was conducted and the medical records of RA patients with pulmonary involvement who admitted to ICU in a large tertiary hospital from January 2014 to May 2025 were reviewed. A total of twenty patients were enrolled during the study period. The leading causes of ICU admission were interstitial lung disease with respiratory failure, followed by severe pneumonia. Eight patients died within 30 days after admission to ICU. Infections led to a fatal outcome in most cases. Poor prognostic factors in the non-survival group were lower oxygenation index, renal dysfunction, higher SOFA scores, invasive mechanical ventilation and vasoactive medication requirement. The study emphasizes RA patients in ICU have a rather poor prognosis, particularly in the presence of pulmonary involvement. Early and accurate diagnosis of critical conditions, along with timely and appropriate interventions, is essential to reduce mortality.

Metrics

Metrics Loading ...

References

Janssen NM, Karnad DR, Guntupalli KK. Rheumatologic diseases in the intensive care unit: epidemiology, clinical approach, management, and outcome. Crit Care Clin. 2002;18:729-48. DOI: https://doi.org/10.1016/S0749-0704(02)00025-8

Quintero OL, Rojas-Villarraga A, Mantilla RD. Autoimmune diseases in the intensive care unit. An update. Autoimmun Rev. 2013;12:380-95. DOI: https://doi.org/10.1016/j.autrev.2012.06.002

Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388:2023-38. DOI: https://doi.org/10.1016/S0140-6736(16)30173-8

Fujiwara T, Tokuda K, Momii K. Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units. BMC Rheumatol. 2020;4:64. DOI: https://doi.org/10.1186/s41927-020-00164-1

Avouac J, Amrouche F, Meune C. Mortality profile of patients with rheumatoid arthritis in France and its change in 10 years. Semin Arthritis Rheum. 2017;46:537-43. DOI: https://doi.org/10.1016/j.semarthrit.2016.10.007

Dadoun S, Zeboulon-Ktorza N, Combescure C. Mortality in rheumatoid arthritis over the last fifty years: systematic review and meta-analysis. Joint Bone Spine. 2013;80:29-33. DOI: https://doi.org/10.1016/j.jbspin.2012.02.005

Baviera M, Cioffi G, Colacioppo P. Temporal trends from 2005 to 2018 in deaths and cardiovascular events in subjects with newly diagnosed rheumatoid arthritis. Intern Emerg Med. 2021;16:1467-75. DOI: https://doi.org/10.1007/s11739-020-02581-z

Otsuka J, Yoshizawa S, Kudo K. Clinical features of acute exacerbation in rheumatoid arthritis-associated interstitial lung disease: Comparison with idiopathic pulmonary fibrosis. Respir Med. 2022;200:106898. DOI: https://doi.org/10.1016/j.rmed.2022.106898

Garland A, Olafson K, Ramsey CD. A population-based observational study of intensive care unit-related outcomes. With emphasis on post-hospital outcomes. Ann Am Thorac Soc. 2015;12:202-8. DOI: https://doi.org/10.1513/AnnalsATS.201405-201CME

Haviv-Yadid Y, Segal Y, Dagan A. Mortality of patients with rheumatoid arthritis requiring intensive care: a single-center retrospective study. Clin Rheumatol. 2019;38:3015-23. DOI: https://doi.org/10.1007/s10067-019-04651-w

Peschken CA, Hitchon CA, Garland A. A Population-based Study of Intensive Care Unit Admissions in Rheumatoid Arthritis. J Rheumatol. 2016;43:26-33. DOI: https://doi.org/10.3899/jrheum.150312

Barrett O, Abramovich E, Dreiher J. Short- and long-term mortality due to sepsis in patients with rheumatoid arthritis. Rheumatol Int. 2017;37:1021-6. DOI: https://doi.org/10.1007/s00296-017-3694-5

Qiu M, Jiang J, Nian X. Factors associated with mortality in rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis. Respir Res. 2021;22:264. DOI: https://doi.org/10.1186/s12931-021-01856-z

Bongartz T, Nannini C, Medina-Velasquez YF. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis Rheum. 2010;62:1583-91. DOI: https://doi.org/10.1002/art.27405

Raimundo K, Solomon JJ, Olson AL. Rheumatoid Arthritis-Interstitial Lung Disease in the United States: Prevalence, Incidence, and Healthcare Costs and Mortality. J Rheumatol. 2019;46:360-9. DOI: https://doi.org/10.3899/jrheum.171315

Hyldgaard C, Ellingsen T, Hilberg O. Rheumatoid Arthritis-Associated Interstitial Lung Disease: Clinical Characteristics and Predictors of Mortality. Respiration. 2019;98:455-60. DOI: https://doi.org/10.1159/000502551

Nakajima A, Inoue E, Tanaka E. Mortality and cause of death in Japanese patients with rheumatoid arthritis based on a large observational cohort, IORRA. Scand J Rheumatol. 2010;39:360-7. DOI: https://doi.org/10.3109/03009741003604542

Lee EE, Shin A, Lee J. All-cause and cause-specific mortality of patients with rheumatoid arthritis in Korea: A nation-wide population-based study. Joint Bone Spine. 2021;89:105269. DOI: https://doi.org/10.1016/j.jbspin.2021.105269

Mehta B, Pedro S, Ozen G. Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study. RMD Open. 2019;5:935. DOI: https://doi.org/10.1136/rmdopen-2019-000935

Kakutani T, Hashimoto A, Tominaga A. Related factors, increased mortality and causes of death in patients with rheumatoid arthritis-associated interstitial lung disease. Mod Rheumatol. 2020;30:458-64. DOI: https://doi.org/10.1080/14397595.2019.1621462

Yamakawa H, Ogura T, Kameda H. Decision-making strategy for the treatment of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). J Clin Med. 2021;10. DOI: https://doi.org/10.3390/jcm10173806

Huang S, Kronzer VL, Dellaripa PF. Rheumatoid arthritis-associated interstitial lung disease: Current update on prevalence, risk factors, and pharmacologic treatment. Curr Treatm Opt Rheumatol. 2020;6:337-53. DOI: https://doi.org/10.1007/s40674-020-00160-z

Kameda H. DLI Caused by Disease-Modifying Antirheumatic Drugs: What Are the Characteristics of DLI by Disease-Modifying Antirheumatic Drugs. Drug-Induced Lung Injury. 2018;3:45-9. DOI: https://doi.org/10.1007/978-981-10-4466-3_12

Yamano Y, Taniguchi H, Kondoh Y. Multidimensional improvement in connective tissue disease-associated interstitial lung disease: Two courses of pulse dose methylprednisolone followed by low-dose prednisone and tacrolimus. Respirology. 2018;23:1041-8. DOI: https://doi.org/10.1111/resp.13365

Hallowell RW, Horton MR. Interstitial lung disease in patients with rheumatoid arthritis: spontaneous and drug induced. Drugs. 2014;74:443-50. DOI: https://doi.org/10.1007/s40265-014-0190-z

Song JW, Lee HK, Lee CK. Clinical course and outcome of rheumatoid arthritis-related usual interstitial pneumonia. Sarcoidosis Vasc Diffuse Lung Dis. 2013;30:103-12.

Carmona EM, Limper AH. Update on the diagnosis and treatment of Pneumocystis pneumonia. Journal of Health & Sports Science Juntendo University. 2011;34:76-87.

Kelly C, Palmer E, Gordon J. Pulsed cyclophosphamide in the treatment of rheumatoid arthritis-related interstitial lung disease (RA-ILD). Ann Rheum Dis. 2014;73:74-74. DOI: https://doi.org/10.1136/annrheumdis-2014-eular.2342

Innabi A, Gomez-Manjarres D, Alzghoul BN. Cyclophosphamide for the treatment of Acute Exacerbation of Interstitial Lung Disease: A Review of the Literature. Sarcoidosis Vasc Diffuse Lung Dis. 2021;38:202.

Pugashetti JV, Lee JS. Overview of rheumatoid arthritis-associated interstitial lung disease and its treatment. Semin Respir Crit Care Med. 2024;45:329-41. DOI: https://doi.org/10.1055/s-0044-1782218