Lung involvement prevalence in patients with early rheumatoid arthritis without known pulmonary disease: a multicentric cross sectional study

Abstract

Background Clinically evident interstitial lung disease (ILD) affects between 10 and 42% of the patients with rheumatoid arthritis (RA). Airway involvement seems to be even more common. Most of the available evidence comes from studies performed in established RA patients. The aim of our study was to know the prevalence of non-diagnosed lung disease (airway and interstitial involvement) in patients with early RA and look for associated factors. Methods We designed an observational, multicenter, cross-sectional study, and included patients with RA of less than two years since diagnosis. We performed a structured questionnaire, HRCT and lung functional tests looking for lung disease, together with joint disease evaluation. We analyzed which variables were associated with the presence of lung disease on HRCT. Results We included 83 patients, 83% females. The median (IQR) of time since RA diagnosis was 3 (1–6) months. In the HRCT, 57 patients had airway compromisea (72%), and 6 had interstitial abnormalities (7.5%). The most common altertion found in lung functional tests was a reduced DLCO (14%). The presence of at least one abnormality in the physical exam was associated with lung involvement on HRCT [13 (21.6%) vs 0 (0%); p = 0.026]. Also, patients with lung involvement presented significantly lower values of FVC% and DLCO%, and higher values of RV/TLC. No variable related to joint involvement was found associated with alterations in HRCT. Conclusion Our study shows that a large proportion of early RA patients has abnormal findings in HRCT. Further studies are required to confirm these findings.

Application of impulse oscillometry to detect interstitial lung disease and airway disease in adults with rheumatoid arthritis

“…Paulin et al found that a signi cant percentage (72.2%, 60/83) of early RA patients had abnormal results on HRCT scans. In addition, patients with lung involvement had notably lower FVC% and DLCO% values, as well as higher RV/TLC values (24). Pulmonary function test parameters, such as %DLCO, FEV1/FVC, and %FEF25-75, have been used for assessing functional impairment in pulmonary manifestations linked to RA (9,23).…”

Clinical Presentation of Connective Tissue Disease Patients with and without Interstitial Lung Disease: A Retrospective Study

“…In detail, RA patients were more numerous in the RU cohort than in the PU cohort. This could be explained by the low incidence of significant ILD in early RA [31]. No significant differences in the prevalence of classification criteria between the two cohorts of RA patients were noted.…”

Unmet needs and perspectives in rheumatoid arthritis-associated interstitial lung disease: A critical review

“…Second, with the adoption of HRCT in clinical practice, an increase in RA-ILD prevalence has been observed over time ( 16 ). ILD has been detected in up to 7.5% subjects with early RA ( 17 ), while interstitial lung abnormalities (ILA, vide infra ) may be more common ( 18 ). It has been estimated that 10% patients with established RA have clinically significant ILD (i.e., signs and symptoms, latent respiratory insufficiency, severe lung function impairment) ( 19 ).…”