Patients with limited rheumatoid arthritis-related interstitial lung disease have a better prognosis than those with extensive disease

Sathi, Navtej; Urwin, Thomas; Desmond, S.; Dawson, Julie

doi:10.1093/rheumatology/keq426

Cited by 37 publications

(26 citation statements)

References 5 publications

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“…The application of this staging system to RA-ILD demonstrated a better prognosis with limited disease. 57 The second system suggests dividing individuals with RA-ILD into three broad categories: (1) asymptomatic, incidentally discovered ILD (subclinical disease); (2) limited ILD ( , 20%) on HRCT scan with gradually increasing symptoms of dyspnea and slow decline in pulmonary function tests (PFTs); and (3) extensive ILD on HRCT scan with rapidly progressive course and rapidly declining PFTs. 23 indicative of subclinical disease, and a substantial minority will develop clinically evident RA-ILD over time ( Fig 2 ).…”

Section: Treatmentmentioning

confidence: 99%

A Roadmap to Promote Clinical and Translational Research in Rheumatoid Arthritis-Associated Interstitial Lung Disease

Doyle

Lee

Dellaripa

et al. 2014

Chest

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Rheumatoid arthritis (RA) is a systemic inflammatory disorder affecting approximately 1.3 million adults in the United States. Approximately 10% of these individuals with RA have clinically evident interstitial lung disease (RA-ILD), and an additional one-third demonstrate subclinical ILD on chest CT scan. The risk of death for individuals with RA-ILD is three times higher than for patients with RA without ILD, with a median survival after ILD diagnosis of only 2.6 years. Despite the high prevalence and mortality of RA-ILD, little is known about its molecular features and its natural history. At present, we lack a standard validated approach to the definition, diagnosis, risk stratification, and management of RA-ILD. In this perspective, we discuss the importance of clinical and translational research and how ongoing research efforts can address important gaps in our knowledge over the next few years. Furthermore, recommendations are made to design multicenter collaborative studies that will expedite the development of clinical trials designed to decrease the significant morbidity and mortality associated with RA-ILD.

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Section: Treatmentmentioning

confidence: 99%

A Roadmap to Promote Clinical and Translational Research in Rheumatoid Arthritis-Associated Interstitial Lung Disease

Doyle

Lee

Dellaripa

et al. 2014

Chest

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“…ILD is a major complication in RA, where prognosis is influenced by the presence of pulmonary active disease and severity of the lung involvement. Sathi et al described that patients with RA with findings of more extensive lung disease on HRCT have a worse prognosis compared with patients with RA with limited ILD [ 14 ]. Currently, the extent and severity of ILD on HRCT and not merely the presence of ILD are considered as factors associated with the prognosis, leading to the development of tomographically validated scales to identify the severity of the lung involvement.…”

Section: Introductionmentioning

confidence: 99%

Anti-Cyclic Citrullinated Peptide Antibodies and Severity of Interstitial Lung Disease in Women with Rheumatoid Arthritis

Rocha-Muñoz

Ponce-Guarneros

Gámez-Nava

et al. 2015

Journal of Immunology Research

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Objective. To evaluate whether serum titers of second-generation anticyclic citrullinated peptide antibodies (anti-CCP2) are associated with the severity and extent of interstitial lung disease in rheumatoid arthritis (RA-ILD). Methods. In across-sectional study, 39 RA-ILD patients confirmed by high-resolution computed tomography (HRCT) were compared with 42 RA without lung involvement (RA only). Characteristics related to RA-ILD were assessed in all of the patients and serum anti-CCP2 titers quantified. Results. Higher anti-CCP2 titers were found in RA-ILD compared with RA only (medians 77.9 versus 30.2 U/mL, P < 0.001). In the logistic regression analysis after adjustment for age, disease duration (DD), smoke exposure, disease activity, functioning, erythrocyte sedimentation rate, and methotrexate (MTX) treatment duration, the characteristics associated with RA-ILD were higher anti-CCP2 titers (P = 0.003) and + RF (P = 0.002). In multivariate linear regression, the variables associated with severity of ground-glass score were anti-CCP2 titers (P = 0.02) and with fibrosis score DD (P = 0.01), anti-CCP2 titers (P < 0.001), and MTX treatment duration (P < 0.001). Conclusions. Anti-CCP2 antibodies are markers of severity and extent of RA-ILD in HRCT. Further longitudinal studies are required to identify if higher anti-CCP2 titers are associated with worst prognosis in RA-ILD.

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“…HRCT of the thorax is the gold-standard investigation 23 which confirms ILD and defines whether it is an extensive disease (involving > 20% of total lung volume) or a limited disease (< 20% of total lung volume). [24][25] As seen in our case, the presence [36][37] Cyclophosphamide has been found to be therapeutic in methotrexate-induced pneumonitis that has not been responsive to the usual methotrexate discontinuation, oxygen therapy, and/or corticosteroids. 38 Due to the lack of controlled studies, optimal Other ancillary treatments include annual influenza and pneumococcal vaccinations, which help prevent respiratory infections in RA-ILD patients, home oxygen support, 23…”

Section: Case Summarymentioning

confidence: 65%

Rheumatoid or Methotrexate Induced Interstitial Lung Disease? – A Clinical Dilemma

Tan

2014

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Rheumatoid arthritis (RA)-associated interstitial lung disease (RA-ILD) is an increasingly common extra-articular cause of mortality and morbidity in RA. Here, we present the case of an 82-year-old female suffering from RA-ILD. She presented with a 20-year history of RA with new-onset progressively worsening dyspnoea, pyrexia, and dry cough, which were not responsive to initial antibiotics. Moreover, she had been on long-term methotrexate, which can cause pulmonary disease. Investigations revealed raised inflammatory markers, restrictive lung patterns, and radiological features of ILD. She was treated with a tapering course of oral prednisolone and home oxygen, which provided some symptomatic improvement. Diagnosis of RA-ILD can be challenging due to several contributing factors. Optimal treatment is controversial, and corticosteroids have been widely used but with limited effects. There is evidence directed at potential therapeutic benefit from a number of newer agents, which are discussed.

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Patients with limited rheumatoid arthritis-related interstitial lung disease have a better prognosis than those with extensive disease

Cited by 37 publications

References 5 publications

A Roadmap to Promote Clinical and Translational Research in Rheumatoid Arthritis-Associated Interstitial Lung Disease

A Roadmap to Promote Clinical and Translational Research in Rheumatoid Arthritis-Associated Interstitial Lung Disease

Anti-Cyclic Citrullinated Peptide Antibodies and Severity of Interstitial Lung Disease in Women with Rheumatoid Arthritis

Rheumatoid or Methotrexate Induced Interstitial Lung Disease? – A Clinical Dilemma

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