Heterogeneity in rheumatoid arthritis-associated interstitial lung disease: time for splitting?

Kawano-Dourado, Letícia; Bonfiglioli, Karina Rossi

doi:10.36416/1806-3756/e20220426

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“…A AR-DPI pode determinar um espectro variado de apresentações, de agudas a crônicas, incluindo dano alveolar difuso (DAD), pneumonia em organização (PO) e distúrbios fibróticos. (8) Os fatores de risco para AR-DPI incluem tabagismo, sexo masculino, idade mais avançada, duração/atividade da AR e soropositividade para fator reumatoide ou anticorpos antipeptídeos citrulinados cíclicos. (2,9) Pacientes com AR raramente precisam ser submetidos à biópsia pulmonar para confirmar o diagnóstico de DPI, que na maioria das vezes é baseado em padrões tomográficos.…”

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Tomographic pleuropulmonary manifestations in rheumatoid arthritis: a pictorial essay

et al. 2023

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Rheumatoid arthritis (RA) is an autoimmune inflammatory and heterogeneous disease that affects several systems, especially the joints. Among the extra-articular manifestations of RA, pleuropulmonary involvement occurs frequently, with different presentations, potentially in all anatomic thoracic compartments, and may determine high morbidity and mortality. The most common pleuropulmonary manifestations in patients with RA include interstitial lung disease (ILD), pleural disease, pulmonary arterial hypertension, rheumatoid lung nodules, airway disease (bronchiectasis and bronchiolitis), and lymphadenopathy. Pulmonary hypertension and ILD are the manifestations with the greatest negative impact in prognosis. HRCT of the chest is essential in the evaluation of patients with RA with respiratory symptoms, especially those with higher risk factors for ILD, such as male gender, smoking, older age, high levels of rheumatoid factor, or positive anti-cyclic citrullinated peptide antibody results. Additionally, other etiologies that may determine tomographic pleuropulmonary manifestations in patients with RA are infections, neoplasms, and drug-induced lung disease. In these scenarios, clinical presentation is heterogeneous, varying from being asymptomatic to having progressive respiratory failure. Knowledge on the potential etiologies causing tomographic pleuropulmonary manifestations in patients with RA coupled with proper clinical reasoning is crucial to diagnose and treat these patients.

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“…RA-ILD may determine a variable spectrum of presentations, from acute to chronic ones, including diffuse alveolar damage (DAD), organizing pneumonia (OP), and fibrotic disorders. 8 …”

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confidence: 99%