Baseline Disease Activity and Moderate-to-High Disease Activity at 6 Months in Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Multicentre Real-World Study from the ANSWER Cohort
9 affiliations
- 1Division of Rheumatology, Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
- 2Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki 710-0051, Okayama, Japan
- 3Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Kyoto, Japan
- 4Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, The University of Osaka, Suita 565-0871, Osaka, Japan
- 5Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
- 6Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
- 7Department of Clinical Immunology, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Osaka, Japan
- 8First Department of Internal Medicine, Kansai Medical University, Hirakata 573-1010, Osaka, Japan
- 9Department of Hematology and Rheumatology, Kindai University School of Medicine, Osakasayama 589-8511, Osaka, Japan
Abstract
Background/Objectives: In rheumatoid arthritis-associated interstitial lung disease (RA-ILD), factors associated with moderate-to-high disease activity (MDA/HDA) during follow-up are not well defined. We examined baseline factors associated with MDA/HDA at 6 months. Methods: We analyzed 278 patients with RA-ILD from the multicentre ANSWER cohort. At 6 months, patients were classified by the 28-joint Disease Activity Score using erythrocyte sedimentation rate (DAS28-ESR) as remission/low disease activity (LDA) or MDA/HDA. Logistic regression used age and baseline DAS28-ESR as continuous variables (n = 178 with complete baseline DAS28-ESR); discrimination, calibration and optimism (1000 bootstrap resamples) were assessed. A sensitivity analysis used the ESR-free Clinical Disease Activity Index (CDAI) as the outcome. Results: In all, 148 patients achieved remission/LDA and 130 had MDA/HDA. Baseline DAS28-ESR was independently associated with MDA/HDA (odds ratio 2.01 per point, 95% CI 1.57–2.57), as was age (1.05 per year, 1.01–1.08). The area under the curve was 0.768 for DAS28-ESR alone and 0.776 with age added; internal validation of the two-variable model showed little estimated optimism (corrected area 0.772, calibration slope 0.984, 95% CI 0.693–1.396). With the CDAI-based outcome, the association with age was not reproduced (odds ratio 1.00, 0.97–1.04). Conclusions: Baseline disease activity is strongly associated with MDA/HDA at 6 months in RA-ILD. The incremental value of age was small, and the association with age was not reproduced when the outcome was defined by the CDAI. The age finding should therefore be regarded as secondary and dependent on the disease activity measure used. External and prospective validation is required before these findings are applied clinically.
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BibTeX
@article{yoshikawa2026baseline,
title = {{Baseline Disease Activity and Moderate-to-High Disease Activity at 6 Months in Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Multicentre Real-World Study from the ANSWER Cohort}},
author = {Ayaka Yoshikawa and Takuya Kotani and Wataru Yamamoto and Kenichiro Hata and Koji Nagai and Hideyuki Shiba and Yuri Hiramatsu and Yumiko Wada and Koichi Murata and Hideo Onizawa and Kohei Tsujimoto and Iku Shirasugi and Masanori Tsubosaka and Motomu Hashimoto and Masao Katsushima and Yonsu Son and Naofumi Yoshida and Yuji Nozaki and Chisato Ashida and Tohru Takeuchi},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218267},
url = {https://www.mdpi.com/2077-0383/15/21/8267},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Baseline Disease Activity and Moderate-to-High Disease Activity at 6 Months in Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Multicentre Real-World Study from the ANSWER Cohort
AU - Ayaka Yoshikawa
AU - Takuya Kotani
AU - Wataru Yamamoto
AU - Kenichiro Hata
AU - Koji Nagai
AU - Hideyuki Shiba
AU - Yuri Hiramatsu
AU - Yumiko Wada
AU - Koichi Murata
AU - Hideo Onizawa
AU - Kohei Tsujimoto
AU - Iku Shirasugi
AU - Masanori Tsubosaka
AU - Motomu Hashimoto
AU - Masao Katsushima
AU - Yonsu Son
AU - Naofumi Yoshida
AU - Yuji Nozaki
AU - Chisato Ashida
AU - Tohru Takeuchi
PY - 2026
DA - 2026/10/23
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218267
UR - https://www.mdpi.com/2077-0383/15/21/8267
AB - Background/Objectives: In rheumatoid arthritis-associated interstitial lung disease (RA-ILD), factors associated with moderate-to-high disease activity (MDA/HDA) during follow-up are not well defined. We examined baseline factors associated with MDA/HDA at 6 months. Methods: We analyzed 278 patients with RA-ILD from the multicentre ANSWER cohort. At 6 months, patients were classified by the 28-joint Disease Activity Score using erythrocyte sedimentation rate (DAS28-ESR) as remission/low disease activity (LDA) or MDA/HDA. Logistic regression used age and baseline DAS28-ESR as continuous variables (n = 178 with complete baseline DAS28-ESR); discrimination, calibration and optimism (1000 bootstrap resamples) were assessed. A sensitivity analysis used the ESR-free Clinical Disease Activity Index (CDAI) as the outcome. Results: In all, 148 patients achieved remission/LDA and 130 had MDA/HDA. Baseline DAS28-ESR was independently associated with MDA/HDA (odds ratio 2.01 per point, 95% CI 1.57–2.57), as was age (1.05 per year, 1.01–1.08). The area under the curve was 0.768 for DAS28-ESR alone and 0.776 with age added; internal validation of the two-variable model showed little estimated optimism (corrected area 0.772, calibration slope 0.984, 95% CI 0.693–1.396). With the CDAI-based outcome, the association with age was not reproduced (odds ratio 1.00, 0.97–1.04). Conclusions: Baseline disease activity is strongly associated with MDA/HDA at 6 months in RA-ILD. The incremental value of age was small, and the association with age was not reproduced when the outcome was defined by the CDAI. The age finding should therefore be regarded as secondary and dependent on the disease activity measure used. External and prospective validation is required before these findings are applied clinically.
SN - 2077-0383
ER -