Clinical, serological and radiological findings in patients with rheumatoid arthritis from Zanzibar comparing those with and without interstitial lung disease

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Objectives: To describe the prevalence, characteristics, and outcomes of patients with rheumatoid arthritis (RA) associated interstitial lung disease (ILD) in a multi‐centre cohort. Methods: We collected data from 132 patients with RA prospectively over a four‐year period. Baseline socio‐demographic characteristics (age, sex, smoking status, disease duration, time to diagnosis) were obtained. Patients were also assessed clinically to determine articular disease activity as well as to identify any respiratory involvement. Baseline chest radiographs were requested for all participants and those with findings suggestive of possible lung disease underwent high‐resolution computed tomography (HRCT) to assess whether ILD was present. All patients with confirmed ILD were given rituximab monotherapy at recommended doses. Results: From a cohort of 132 adult RA patients, four were found to have RA‐ILD on HRCT giving a prevalence of 3%. They had a mean age of 55 ± 18.5 years with three of them being female. They had long standing RA with significant delay in time to diagnosis. None of our patients were smokers but all were strongly seropositive. Non-specific interstitial pneumonia (NSIP) was diagnosed in two patients while usual interstitial pneumonia (UIP) was diagnosed in the remaining two. All patients benefitted from rituximab monotherapy as evidenced by improvement in respiratory symptoms, combined with non-progression on repeat HRCT, in tandem with clinical disease activity scores. Conclusion: Although our patient numbers were small, our paper describes epidemiological differences in RA‐ILD for our patients when compared with patients in the West. Rituximab showed promising results in our patients, but results must clearly be interpreted with caution.