Baseline Characteristics and Progression of a Spectrum of Interstitial Lung Abnormalities and Disease in Rheumatoid Arthritis

Leticia Kawano-Dourado, Tracy J Doyle, Karina Bonfiglioli, Márcio V Y Sawamura, Renato H Nakagawa, Fábio E Arimura, Hye J Lee, Diana Arrais de Souza Rangel, Cleonice Bueno, Carlos R R Carvalho, Maria Laura Sabbag, Camila Molina, Ivan O Rosas, Ronaldo A Kairalla, Leticia Kawano-Dourado, Tracy J Doyle, Karina Bonfiglioli, Márcio V Y Sawamura, Renato H Nakagawa, Fábio E Arimura, Hye J Lee, Diana Arrais de Souza Rangel, Cleonice Bueno, Carlos R R Carvalho, Maria Laura Sabbag, Camila Molina, Ivan O Rosas, Ronaldo A Kairalla

Abstract

Background: Interstitial lung abnormalities (ILA) and interstitial lung disease (ILD) are seen in up to 60% of individuals with rheumatoid arthritis (RA), some of which will progress to have a significant impact on morbidity and mortality rates. Better characterization of progressive interstitial changes and identification of risk factors that are associated with progression may enable earlier intervention and improved outcomes.

Research question: What are baseline characteristics associated with RA-ILD progression?

Study design and methods: We performed a retrospective study in which all clinically indicated CT chest scans in adult individuals with RA from 2014 to 2016 were evaluated for interstitial changes, and the data were further subdivided into ILA and ILD based on clinical record review. Progression was determined visually and subsequently semiquantified.

Results: Those individuals with a spectrum of interstitial changes (64 of 293) were older male smokers and less likely to be receiving biologics/small molecule disease-modifying antirheumatic drugs. Of 44% of the individuals with ILA, 46% had had chest CT scans performed for nonpulmonary indications. Of the 56 individuals with ILA/ILD with sequential CT scans, 38% had evidence of radiologic progression over 4.4 years; 29% of of individuals with ILA progressed. Risk factors for progressive ILA/ILD included a subpleural distribution and higher baseline involvement.

Interpretation: Of 293 individuals with RA with clinically indicated CT scans, interstitial changes were observed in 22%, one-half of whom had had a respiratory complaint at the time of imaging; radiologic progression was seen in 38%. Of individuals with progressive ILA, one-half had had baseline CT scans performed for nonpulmonary indications. Subpleural distribution and higher baseline ILA/ILD extent were risk factors associated with progression. Prospective longitudinal studies of RA-ILA are necessary.

Keywords: interstitial lung disease; pulmonary fibrosis; radiology; rheumatoid arthritis; thoracic.

Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Flow diagram of subject inclusion. HRCT = high-resolution CT; ILA = interstitial lung abnormalities; ILD = interstitial lung disease; RA = rheumatoid arthritis
Figure 2
Figure 2
A-B, ILA/ILD extent percent of baseline and follow-up CT scan stratified as progressors and nonprogressors based on high-resolution CT analysis. Spectrum of A, ILA/ILD (n = 56) and B, ILA (n = 21). Note that probability values over the box plots represent the comparison between progressors vs nonprogressors at each point in time. The probability value next to the horizontal arrow represents the comparison between the variation of the ILA/ILD extend seen among nonprogressors vs progressors. See Figure 1 legend for expansion of abbreviations.

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