Baseline Characteristics and Progression of a Spectrum of Interstitial Lung Abnormalities and Disease in Rheumatoid Arthritis

Abstract

BACKGROUND: Interstitial lung abnormalities (ILA) and interstitial lung disease (ILD) are seen in up to 60% of individuals with rheumatoid arthritis (RA), some of which will progress to have a significant impact on morbidity and mortality rates. Better characterization of progressive interstitial changes and identification of risk factors that are associated with progression may enable earlier intervention and improved outcomes. RESEARCH QUESTION: What are baseline characteristics associated with RA-ILD progression? STUDY DESIGN AND METHODS: We performed a retrospective study in which all clinically indicated CT chest scans in adult individuals with RA from 2014 to 2016 were evaluated for interstitial changes, and the data were further subdivided into ILA and ILD based on clinical record review. Progression was determined visually and subsequently semiquantified.RESULTS: Those individuals with a spectrum of interstitial changes (64 of 293) were older male smokers and less likely to be receiving biologics/small molecule disease-modifying antirheumatic drugs. Of 44% of the individuals with ILA, 46% had had chest CT scans performed for nonpulmonary indications. Of the 56 individuals with ILA/ILD with sequential CT scans, 38% had evidence of radiologic progression over 4.4 years; 29% of of individuals with ILA progressed. Risk factors for progressive ILA/ILD included a subpleural distribution and higher baseline involvement.INTERPRETATION: Of 293 individuals with RA with clinically indicated CT scans, interstitial changes were observed in 22%, one-half of whom had had a respiratory complaint at the time of imaging; radiologic progression was seen in 38%. Of individuals with progressive ILA, one-half had had baseline CT scans performed for nonpulmonary indications. Subpleural distribution and higher baseline ILA/ILD extent were risk factors associated with progression. Prospective longitudinal studies of RA-ILA are necessary.

RETRACTED: Connective tissue disease-related interstitial lung disease (CTD-ILD) and interstitial lung abnormality (ILA): Evolving concept of CT findings, pathology and management

“…The identification of progressive ILA may enable appropriate surveillance and the commencement of treatment with the goal of improving morbidity and mortality rates of established RA-ILD. Kawano-Dourado L et al [ 35 ] performed a longitudinal study in order to characterize risk factors associated with progression in RA-ILA and RA-ILD patients. Of 293 individuals with RA and clinically indicated CT studies, interstitial changes were observed in 22 % (64 of 293; older male smokers), one half of whom had a respiratory complaint at the time of imaging.…”

Interstitial lung abnormalities a risk factor for rheumatoid arthritis interstitial lung disease progression: what's new

“…The data of Kawano et al [9] are consistent with those previously reported in literature regarding the prevalence of ILA/ILD in RA [11][12][13][14], such as the baseline demographic characteristics (male sex, older age and smoking history) associated with ILA/ILD [8,12,15,16].…”

“…K awano et al [ 9 ] undertook a monocentric, retrospective, observational cohort study. All the adult subjects with a diagnosis of RA, made according to international consensus, seen at the rheumatology clinic from 2014 to 2016 who underwent a chest computed tomography (CT) scan as part of their clinical evaluation entered the study.…”

“…RA), they could not be labelled as ILA, since they are not incidental findings, and should be considered pre-clinical ILDs. Clinician should actively and promptly investigate this condition through accurate clinical examination, lung function and exercise tests, as well as chest CT. Figure 2b in Kawano et al [9] shows that the ILA extent (%) evaluation from five slices of the CT scan can differentiate progressors versus nonprogressors. Given the high prevalence of interstitial abnormalities in RA subjects, low-dose CT or limited slices CT might be used for screening and, more importantly, for follow-up of pre-clinical ILDs in this population.…”

“…K awano et al [ 9 ] focused their attention not only on the clinically evident RA-ILD, but also on RA-ILA trying to measure its prevalence and determine the risk factors for its progression.…”