Asymptomatic Preclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease

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.

Association of Single Nucleotide Polymorphisms of PADI4 and HLA-DRB1 Alleles with Susceptibility to Rheumatoid Arthritis-Related Lung Diseases

“…RA-related interstitial lung disease (RA-ILD) is increasingly recognized and is clinically significant in 5-10 % of RA patients [4,5]. Using high-resolution computed tomography (HRCT) scanning, the estimated prevalence of ILD and airway disease among RA patients was 19-56 % [6][7][8] and 25-30 % [9-11], respectively. In spite of this Electronic supplementary material The online version of this article (doi:10.1007/s00408-016-9916-x) contains supplementary material, which is available to authorized users.…”

High-resolution CT and pulmonary function tests in rheumatoid arthritis patients with subclinical interstitial lung disease in Kuwait

“…They found no significant correlation between HRCT findings and disease activity, RF positivity, PFT results and disease duration. In the study of Chen et al [24] the overall prevalence of radiologically defined RA-ILD in RA patients was high (61%) though the frequency of clinically evident ILD was only Table 4 Comparison of demographic features, disease activity, immune profile and PFT between RA patients with and without ILD. 6%.…”

The onset site of rheumatoid arthritis: the joints or the lung?

“…Symptoms complained of by RA patients with ILD include various degrees of exertional dyspnoea and coughing that require further investigation with pulmonary function tests (PFT), chest X-ray and eventually HRCT. However, the diagnosis of RA-ILD may often be incidental as 30-90% of patients with RA-ILD, according to different studies, may have no or very mild respiratory symptoms (10,11). The burden of clinically manifest ILD on RA prognosis is critical, with an overall median survival ranging between 2.6 and 8.1 years after diagnosis.…”

“…Moreover, a recent meta-analysis reported that RA-ILD is not significantly associated with ACPA in a specific ethnic group, namely a subset of Asian RA patients (23). Since RF/ACPA positivity is associated with more severe articular disease, the fact that joint disease severity appears to be linked to RA-ILD is easy to explain (10,13).…”