Asymptomatic preclinical rheumatoid arthritis-associated interstitial lung disease
Juan Chen, YongHong Shi, XiaoPing Wang, Heqing Huang, Dana Ascherman, Juan Chen, YongHong Shi, XiaoPing Wang, Heqing Huang, Dana Ascherman
Abstract
Objective: Interstitial lung disease (ILD) is a common extra-articular manifestation of rheumatoid arthritis (RA) and a significant cause of morbidity and mortality. The objective of this study was to define high-resolution chest CT (HRCT) and pulmonary function test (PFT) abnormalities capable of identifying asymptomatic, preclinical forms of RA-ILD that may represent precursors to more severe fibrotic lung disease.
Methods: We analyzed chest HRCTs in consecutively enrolled RA patients and subsequently classified these individuals as RA-ILD or RA-no ILD based on the presence/absence of ground glass opacification, septal thickening, reticulation, traction bronchiectasis, and/or honeycombing. Coexisting PFT abnormalities (reductions in percent predicted FEV1, FVC, TLC, and/or DLCO) were also used to further characterize occult respiratory defects.
Results: 61% (63/103) of RA patients were classified as RA-ILD based on HRCT and PFT abnormalities, while 39% (40/103) were designated as RA-no ILD. 57/63 RA-ILD patients lacked symptoms of significant dyspnea or cough at the time of HRCT and PFT assessment. Compared with RA-no ILD, RA-ILD patients were older and had longer disease duration, higher articular disease activity, and more significant PFT abnormalities.
Conclusion: HRCT represents an effective tool to detect occult/asymptomatic ILD that is highly prevalent in our unselected, university-based cohort of RA patients.
References
- Kim EJ, Elicker BM, Maldonado F, et al. Usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease. European Respiratory Journal. 2010;35(6):1322–1328.
- Kim EJ, Collard HR, King TE., Jr. Rheumatoid arthritis-associated interstitial lung disease: the relevance of histopathologic and radiographic pattern. Chest. 2009;136(5):1397–1405.
- Ascherman DP. Interstitial lung disease in rheumatoid arthritis. Current Rheumatology Reports. 2010;12(5):363–369.
- Bongartz T, Nannini C, Medina-Velasquez YF, et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis—a population-based study. Arthritis and Rheumatism. 2010;62(6):1583–1591.
- Sawada T, Inokuma S, Sato T, et al. Leflunomide-induced interstitial lung disease: prevalence and risk factors in Japanese patients with rheumatoid arthritis. Rheumatology. 2009;48(9):1069–1072.
- Picchianti Diamanti A, Germano V, Bizzi E, Laganà B, Migliore A. Interstitial lung disease in rheumatoid arthritis in the era of biologics. Pulmonary Medicine. 2011;2011:5 pages.931342
- Gochuico BR, Avila NA, Chow CK, et al. Progressive preclinical interstitial lung disease in rheumatoid arthritis. Archives of Internal Medicine. 2008;168(2):159–166.
- Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis and Rheumatism. 1988;31(3):315–324.
- Lung function testing: selection of reference values and interpretative strategies. The American Review of Respiratory Disease. 1991;144(5):1202–1218.
- Hamblin MJ, Horton MR. Rheumatoid arthritis-associated interstitial lung disease: diagnostic dilemma. Pulmonary Medicine. 2011;2011:12 pages.872120
- Liote H. Pulmonary manifestation of rheumatoid arthritis. Revue des Maladies Respiratoires. 2008;25(8):973–988.
- Biederer J, Schnabel A, Muhle C, Gross WL, Heller M, Reuter M. Correlation between HRCT findings, pulmonary function tests and bronchoalveolar lavage cytology in interstitial lung disease associated with rheumatoid arthritis. European Radiology. 2004;14(2):272–280.
- Zou Y, Li Y, Ding X, Ying Z. The clinical significance of HRCT in evaluation of patients with rheumatoid arthritis-associated interstitial lung disease: a report from China. Rheumatology International. 2010;32(3):669–673.
Source: PubMed