| Objective(s): In this study,the clinical data of rheumatoid arthritis complicated with interstitial lung disease and rheumatoid arthritis without interstitial lung disease were compared.To explore the clinical characteristics and influencing factors of rheumatoid arthritis complicated with interstitial lung disease.To provide some reference for early clinical identification of this kind of patients,in order to improve the prognosis of patients.Methods: Retrospective analysis of rheumatoid arthritis patients hospitalized in the second affiliated Hospital of Kunming Medical University from January 2017 to October 2022.According to the inclusion and exclusion criteria,80 patients with rheumatoid arthritis complicated with interstitial lung disease and 87 patients with simple rheumatoid arthritis were selected into the group.The general data(sex,age,smoking,RA course,oxygen saturation),clinical manifestations(muscle pain,joint pain,morning stiffness,cough,fever),laboratory indexes(blood cell analysis,infection index,liver enzyme,blood lipid,RA-related antibody,rheumatoid factor)and imaging data of the two groups were collected.The valuable indexes were obtained by comparing the above indexes between the two groups,and the independent risk factors of rheumatoid arthritis complicated with interstitial lung disease were further determined by binary logistics regression analysis.The optimal critical value,sensitivity and specificity of each meaningful measurement index were obtained by using the receiver working characteristic curve(ROC curve).Results:1.Comparison of general data between the two groups: the male ratio(50.0%vs12.6% P=0.001),average age(65.23±10.43vs47.56±11.94 P=0.001),smoking(36.3%vs12.6% P=0.001),course of RA(5.00vs2.00,P=0.017)in rheumatoid arthritis with interstitial lung disease group were higher than those in non-interstitial lung disease group,and the oxygen saturation(91.16%vs96.11% P=0.001)was lower than that in the non-interstitial lung disease group,the difference was statistically significant.2.Comparison of clinical symptoms between the two groups: muscle pain,arthralgia and fever were not statistically significant(P>0.05).The incidence of morning stiffness in rheumatoid arthritis with interstitial lung disease group(35.0%)was lower than that in non-interstitial lung disease group(60.9%),and the difference was statistically significant(P =0.001).The incidence of cough in rheumatoid arthritis with interstitial lung disease group(55.0%)was higher than that in non-interstitial lung disease group(8.0%),and the difference was statistically significant(P=0.001).3.Comparison of blood routine test and infection index between the two groups:the values of white blood cells(P=0.001),neutrophils(P=0.001),NLR(P=0.001),SII(P=0.004)and Hs-CRP(P=0.001)in the rheumatoid arthritis complicated with interstitial lung disease group were higher than those in the non-interstitial lung disease group,while the LMR(P=0.001)value in the rheumatoid arthritis with interstitial lung disease group was lower than that in the control group.There was no significant difference in lymphocyte,eosinophil,basophil,erythrocyte,hemoglobin,platelet,PLR and ESR between the two groups(P>0.05).4.Comparison of biochemical indexes between the two groups: The high-density lipoprotein in rheumatoid arthritis combined with interstitial lung disease group was lower than that in non-interstitial lung disease group(P=0.013),and the comparison of ALT,AST,TBIL,TC,TG and LDL-C is no statistical significance between the two groups(P > 0.05).5.Comparison of immunoglobulin and rheumatoid factor between the two groups:The immunoglobulin Ig G,Ig A and Ig M is no statistical significance between the two groups(P > 0.05),and the rheumatoid factor in rheumatoid arthritis combined with interstitial lung disease group was higher than that in non-interstitial lung disease group,There was no statistically significant difference(P > 0.05).6.Comparison of RA-related antibodies between the two groups: the positive rate of antinuclear antibody in rheumatoid arthritis with interstitial lung disease group was lower than that in non-interstitial lung disease group(60.0%vs83.9% P=0.001),and the positive rate of anti-keratin antibody was higher than that in non-interstitial lung disease group(63.8%vs47.1% P=0.031).There was no significant difference in anti-double-stranded DNA,anti-CCP antibody,anti-RA33 antibody and anti-perinuclear factor antibody between the two groups(P > 0.05).7.Comparison of pulmonary artery pressure between the two groups: pulmonary artery pressure in rheumatoid arthritis with interstitial lung disease group was higher than that in non-interstitial lung disease group(34.86 ± 12.86vs28.34 ± 6.04P=0.001).8.Among the HRCT findings of patients with rheumatoid arthritis complicated with interstitial lung disease,patches and stripes(87.5%)were the most common,followed by nodular shadow(46.25%),grid shadow(40%),honeycomb shadow(8.75%),interlobular septal thickening(7.5%),bronchiectasis(6.25%),ground glass shadow(5%).9.The multivariate binary logistics regression analysis of statistically difference data: age(P=0.000,OR=1.158,95%CI:1.074-1.249),course of RA(P=0.031,OR=1.077,95%CI:1.007-1.151),oxygen saturation(P=0.01,OR=0.711,95%CI :0.549-0.921)and cough(P=0.004,OR=11.651,95%CI:2.151-63.110)are independent risk factors of rheumatoid arthritis complicated with interstitial lung disease.10.The value of age,course of disease and oxygen saturation in the diagnosis of rheumatoid arthritis complicated with interstitial lung disease:the critical values of age,course and oxygen saturation were 59.5 years,4.5 years and94.5% respectively,and the areas under the curve were 0.869,0.570 and 0.783 respectively.The sensitivity and specificity were(0.700,0.874),(0.563,0.667),(0.638,0.908),respectively.Conclusion(s):1.Rheumatoid arthritis with male,smoking,older age and long course of RA is more likely to be complicated with interstitial lung disease.2.Rheumatoid arthritis complicated with interstitial lung disease is more prone to low oxygen saturation,cough,and these indicators higher(white blood cells,neutrophils,NLR,SII,C-reactive protein,high density lipoprotein,pulmonary artery pressure),and positive anti-keratin antibody.3.Old age,long course of RA and cough are independent risk factors of rheumatoid arthritis complicated with interstitial lung disease. |
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