Interstitial lung disease reduces achievement of rheumatoid arthritis treatment goals over 24 months

This retrospective observational cohort study included 254 patients with newly diagnosed rheumatoid arthritis who underwent chest computed tomography within one year of disease onset between 2016 and 2022. The primary exposure was the presence of interstitial lung disease (ILD), compared against patients without ILD. Treatment goals were defined as achieving low disease activity, low inflammation, and glucocorticoid-free status. Follow-up assessments occurred at 6, 12, and 24 months after treatment initiation.

At 6 months, patients with ILD achieved treatment goals in 21.2% of cases versus 37.8% in those without ILD (p < 0.05). By 12 months, the achievement rates were 25.0% for patients with ILD compared to 48.9% for those without (p < 0.05). At 24 months, the rates were 21.3% versus 56.8%, respectively (p < 0.01). Multivariate analysis confirmed that ILD was independently and negatively associated with achieving these goals.

No adverse events, serious adverse events, discontinuations, or specific tolerability data were reported in the provided evidence. The study setting was clinical practice. Key limitations include the observational nature of the design, which precludes causal inference, and the lack of reported absolute numbers for the outcomes. Additionally, the study did not report specific safety profiles or discontinuation rates.

The practice relevance indicates that RA-ILD acts as a substantial barrier to the effective implementation of treat-to-target strategies. High baseline CRP and glucocorticoid use at treatment start were also independently negatively associated with goals. Clinicians should recognize that the adverse impact of ILD on treatment goal achievement increases over time.