Prevalence and clinical characteristics of patients with rheumatoid arthritis with interstitial lung disease using unstructured healthcare data and machine learning

• DOI: 10.1136/rmdopen-2023-003353
• Publication Date: 2024-01-31T04:15:42Z
• Authors: Jose A Román Ivorra; Ernesto Trallero-...; Maria Lopez Lasanta; Laura Cebrián; Leticia Lojo; Belén López-Muñíz; Julia Fernández-M...; Belén Núñez; Lucia Silva-Ferná...; Raúl Veiga Cabello; Pilar Ahijado; Isabel De la More...; Nerea Costas Torrijo; Belén Safont; Enrique Ornilla; Juliana Restrepo; Arantxa Campo; Jose L Andreu; Elvira Díez; Alejandra López R...; Elena Bollo; Diego Benavent; David Vilanova; Sara Luján Valdés; Raul Castellanos-...
• Keywords: Adult; :Respiratory Tract Diseases::Lung Diseases::Lung Diseases, Interstitial [DISEASES]; Epidemiology; Pulmonary Fibrosis; Artritis reumatoide - Epidemiologia; Estudios Retrospectivos; Enfermedades Pulmonares Intersticiales; Machine Learning; Arthritis, Rheumatoid; 03 medical and health sciences; 0302 clinical medicine; :Mathematical Concepts::Algorithms::Artificial Intelligence::Machine Learning [PHENOMENA AND PROCESSES]; Aprenentatge automàtic; :conceptos matemáticos::algoritmos::inteligencia artificial::aprendizaje automático [FENÓMENOS Y PROCESOS]; Prevalence; Humans; Retrospective Studies; Adulto; R; :técnicas de investigación::métodos epidemiológicos::recopilación de datos::estadísticas vitales::morbilidad::prevalencia [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS]; :Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::Prevalence [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT]; :enfermedades musculoesqueléticas::artropatías::artritis::artritis reumatoide [ENFERMEDADES]; Humanos; :enfermedades respiratorias::enfermedades pulmonares::enfermedades pulmonares intersticiales [ENFERMEDADES]; Artritis Reumatoide; Medicine; Pulmons - Malalties - Epidemiologia; Lung Diseases, Interstitial; Prevalencia; Aprendizaje Automático; :Musculoskeletal Diseases::Joint Diseases::Arthritis::Arthritis, Rheumatoid [DISEASES]

ObjectivesReal-world data regarding rheumatoid arthritis (RA) and its association with interstitial lung disease (ILD) is still scarce. This study aimed to estimate the prevalence of RA and ILD in patients with RA (RAILD) in Spain, and to compare clinical characteristics of patients with RA with and without ILD using natural language processing (NLP) on electronic health records (EHR).MethodsObservational case–control, retrospective and multicentre study based on the secondary use of unstructured clinical data from patients with adult RA and RAILD from nine hospitals between 2014 and 2019. NLP was used to extract unstructured clinical information from EHR and standardise it into a SNOMED-CT terminology. Prevalence of RA and RAILD were calculated, and a descriptive analysis was performed. Characteristics between patients with RAILD and RA patients without ILD (RAnonILD) were compared.ResultsFrom a source population of 3 176 165 patients and 64 241 683 EHRs, 13 958 patients with RA were identified. Of those, 5.1% patients additionally had ILD (RAILD). The overall age-adjusted prevalence of RA and RAILD were 0.53% and 0.02%, respectively. The most common ILD subtype was usual interstitial pneumonia (29.3%). When comparing RAILD versus RAnonILD patients, RAILD patients were older and had more comorbidities, notably concerning infections (33.6% vs 16.5%, p<0.001), malignancies (15.9% vs 8.5%, p<0.001) and cardiovascular disease (25.8% vs 13.9%, p<0.001) than RAnonILD. RAILD patients also had higher inflammatory burden reflected in more pharmacological prescriptions and higher inflammatory parameters and presented a higher in-hospital mortality with a higher risk of death (HR 2.32; 95% CI 1.59 to 2.81, p<0.001).ConclusionsWe found an estimated age-adjusted prevalence of RA and RAILD by analysing real-world data through NLP. RAILD patients were more vulnerable at the time of inclusion with higher comorbidity and inflammatory burden than RAnonILD, which correlated with higher mortality.