Rheumatoid Arthritis–related Lung Diseases: CT Findings

Tanaka, Nobuyuki; Kim, Jeung Sook; Newell, John D.; Brown, Kevin K.; Cool, Carlyne D.; Meehan, Richard T.; Emoto, Takuya; Matsumoto, Tsuneo; Lynch, David A.

doi:10.1148/radiol.2321030174

Cited by 313 publications

(215 citation statements)

References 43 publications

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“…27 There are data demonstrating excellent correlation between the histopathologic pattern found on surgical lung biopsy and the radiographic pattern found on HRCT scans in patients with IPF. 8,28 The correlation between histopathologic and radiographic patterns in RA-ILD patients has not been as rigorously studied, but it appears that the same correlation is present (Table 1).…”

Section: Ra-ild: Radiographic-histopathologic Correlationmentioning

confidence: 93%

“…Lung biopsy specimens were available in 14 of these 19 patients, and all patients showed UIP pattern. Tanaka et al 27 demonstrated that 41% of a retrospective RA-ILD cohort had UIP pattern seen on HRCT scans, with 30% showing a fibrotic NSIP pattern. Of the 26 patients with UIP pattern seen on HRCT scan, only 4 patients underwent lung biopsies; 2 patients had UIP, and 2 patients had fibrotic NSIP.…”

Section: Ra-ild: Radiographic-histopathologic Correlationmentioning

confidence: 99%

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Rheumatoid Arthritis-Associated Interstitial Lung Disease

Kim

Collard

King

2009

Chest

335

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Section: Ra-ild: Radiographic-histopathologic Correlationmentioning

confidence: 93%

Section: Ra-ild: Radiographic-histopathologic Correlationmentioning

confidence: 99%

Rheumatoid Arthritis-Associated Interstitial Lung Disease

Kim

Collard

King

2009

Chest

335

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“…As abnormal radiological patterns seen on high-resolution computed tomography (HRCT) scans accurately reflect the underlying histological patterns revealed through lung biopsy [9–11], we recently performed HRCT scans on 126 patients with early or longstanding RA [12]. By evaluating one or two predominant abnormalities in each patient’s HRCT findings and observing the distribution and extent of all abnormalities in the lungs, we gave each patient an HRCT-based diagnosis, such as an interstitial pneumonia (IP) pattern or a bronchiolitis pattern.…”

Section: Introductionmentioning

confidence: 99%

Small airway obstruction in patients with rheumatoid arthritis

Mori¹,

Koga²,

Sugimoto

2010

Mod Rheumatol

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This work was intended to evaluate the prevalence of obstructive small-airway disease in patients with rheumatoid arthritis (RA) and its association with clinical characteristics. Pulmonary function testing (PFT) and high-resolution computed tomography (HRCT) were performed on 189 consecutive RA patients. Each case was diagnosed based on abnormal HRCT findings. We defined obstructive dysfunction of small airways as a forced expiratory flow from 25% to 75% of vital capacity (FEF25–75) value >1.96 residual standard deviation (RSD) below predicted values. We found 19 patients (10.1%) with an interstitial pneumonia (IP) pattern and 15 (7.9%) with a bronchiolitis pattern; the other 155 (82.0%) had no abnormal HRCT patterns. In patients with neither abnormal pattern, median values of percentage predicted for carbon monoxide diffusing capacity (DLCO) and ratio of DLCO to alveolar ventilation (DLco/VA) were within the normal range, but median FEF25–75, forced expiratory flow at 25% of vital capacity (V25), and V25/height were <70% of predicted values. Forty-seven patients (30.3%) in this group had obstructive small-airway dysfunction. Multivariate logistic regression analysis indicated that this type of abnormality is strongly associated with respiratory symptoms [odds ratio (OR) 5.18; 95% confidence interval (CI) 1.70–15.75; p = 0.012), smoking history (OR 2.78; 95% CI 1.10–6.99; p = 0.03), and disease duration >10 years (OR 2.86; 95% CI 1.27–6.48; p = 0.012). Parenchymal micronodules, bronchial-wall thickening, and bronchial dilatation on HRCT scans were also predictive factors for abnormal FEF25–75, although these morphological changes were too limited for us to diagnose these patients with the bronchiolitis pattern. Obstructive dysfunction of small airways is apparently common among RA patients, even among those with neither the IP nor the bronchiolitis pattern on HRCT scans. Factors significantly associated with abnormal FEF25–75 are respiratory symptoms, smoking history, and RA duration.

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“…Subsequent intensive studies in collaboration with pathologists and radiologists have endorsed its differentiation from other types of IP, gaining the term NSIP, a broad acceptance [39,40]. NSIP pattern of lung injury, itself further subdivided into cellular and fibrotic NSIP, is the most common pattern of IP in all CTDs except for RA, in which UIP pattern pathology may be more common [41,42]. NSIP lung injury is characterized by diffuse, although often variable, alveolar septal thickening due to collagen deposition.…”

Section: Nonspecific Interstitial Pneumonia (Nsip)mentioning

confidence: 99%

Interstitial Pneumonia Associated with Connective Tissue Disease: An Overview and an Insight

Ishii¹

2017

Contemporary Topics of Pneumonia

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Interstitial pneumonia (IP) refers to involvement of the lung parenchyma by varying degrees of inflammation and fibrosis, in contrast to airspace disease typically seen in bacterial pneumonia. IP lies in the center of a heterogenous group of diffuse interstitial lung diseases (ILDs), either idiopathic or linked to underlying disorders. One of the major categories of disorders frequently associated with IP is a connective tissue disease (CTD), in which autoimmunemediated tissue injury leads to multiple organ impairment. Today, IP represents the most critical pulmonary complication in CTD, resulting in significant morbidity and mortality.Despite growing understanding of the pathology of IPs, as well as the accumulating knowledge from both basic and clinical studies of CTDs, the pathogenesis of CTD-associated IP remains unclear. This chapter will provide an overview of the general understanding of ILD and illustrate the current state of knowledge on IP associated with CTD, in order to fully comprehend the entirety of its complex pictures. Moreover, we will propose a new insight into the immune pathogenesis of CTD-IP by presenting evidence which robustly indicates that T cells trigger initial development of IP in polymyositis/dermatomyositis, suggesting potential approaches for controlling such particular T cells in therapeutic interventions for IP.

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Rheumatoid Arthritis–related Lung Diseases: CT Findings

Abstract: Rheumatoid arthritis is associated with four CT patterns: usual interstitial pneumonia, nonspecific interstitial pneumonia, bronchiolitis, and organizing pneumonia. The most common CT features of rheumatoid arthritis-related lung disease were GGO and reticulation.

Cited by 313 publications

References 43 publications

Rheumatoid Arthritis-Associated Interstitial Lung Disease

Rheumatoid Arthritis-Associated Interstitial Lung Disease

Small airway obstruction in patients with rheumatoid arthritis

Interstitial Pneumonia Associated with Connective Tissue Disease: An Overview and an Insight

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