New Scoring for Recurrence of Anti-aminoacyl-tRNA-Synthetase Antibody-Associated Interstitial Lung Disease

Abstract Background: Antisynthetics syndrome-associated interstitial lung disease (ASS-ILD) recurs in about 56% and its recurrence is associated with poor long-term prognosis. However, there are few reports on risk factors for recurrence of ASS-ILD. So, we investigated ASS-ILD's recurrence factor and aimed to created recurrence factor's scoring for ASS-ILD. Methods: We retrospectively examined ASS-ILD patients from 1 January 2010 to 31 August 2023 at a single center for cumulative reccurence rate.The primary composite outcome was defined as the occurrence of either ASS-ILD reccurence or death due to interstitial pneumonia. Death from other causes was considered a competing risk. Results: Ninety-eight ASS-ILD patients were enrolled. Items extracted as recurrence factors in multivariate analysis were:1) C-reactive protein (CRP) >10ng/dL (p<0.001), 2) Body mass index (BMI) >25kg/m2(p=0.072), 3) acute or subacute (p-=0.008), (4) anti-EJ antibody (p=0.013), (5) anti-KS antibody (p<0.001), (6) anti-Ro52 antibody (p=0.035). Stratified for recurrence in these items, the low group was defined as 1 item or less, the middle group as 2 items (Hazard ratio 2.14), the high group as 3 items or more (Hazard ratio 7.13). Conclusions: CRP >10ng/dL, BMI >25kg/m2, acute or subacute course, anti-EJ antibody, anti-KS antibody, anti-Ro52 antibody were recurrence factors for ASS-ILD. Especially, patients who meet the high group should be monitored closely. It will also be necessary to develop a treatment strategy for each group, including an appropriate method of steroid tapering.