Asymptomatic Preclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease

Juan Chen,Xiaoping Wang,Dana Ascherman,Yonghong Shi,Heqing Huang

doi:10.1155/2013/406927

Juan Chen, Xiaoping Wang + Show 3 more

Open Access

https://doi.org/10.1155/2013/406927

Copy DOI

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.

Highlights

Interstitial lung disease (ILD) is a common extra-articular manifestation responsible for significant morbidity and mortality among patients with rheumatoid arthritis (RA) [1]
Physical examination may reveal inspiratory crackles, and pulmonary function tests (PFTs) typically demonstrate restrictive physiology marked by a reduced diffusing capacity [2, 5]
Demographics, clinical features, medication history, comorbidities, and the disease activity score calculated for 28 joints (DAS28) were carefully recorded

Summary

Introduction

Interstitial lung disease (ILD) is a common extra-articular manifestation responsible for significant morbidity and mortality among patients with rheumatoid arthritis (RA) [1]. These findings parallel the relationship between ILD and other systemic autoimmune diseases such as systemic sclerosis, inflammatory myopathy (polymyositis and dermatomyositis), Sjogren’s syndrome, and undifferentiated CTD [1,2,3]. While the majority of cases of RA-ILD occur in patients between the ages of 50 and 60 years, smoking, male gender, and longstanding RA represent additional risk factors for the development of ILD [2]. But often demonstrate traction bronchiectasis and/or honeycombing suggestive of usual interstitial pneumonia (UIP) [1]

Methods

Results

Conclusion