Rheumatoid Arthritis–associated Interstitial Lung Disease: Radiologic Identification of Usual Interstitial Pneumonia Pattern

Assayag, Deborah; Elicker, Brett M.; Urbania, Thomas H.; Colby, Thomas V.; Kang, Byeong Seong; Ryu, Jay H.; King, Talmadge E.; Collard, Harold R.; Kim, Dong Soon; Lee, Joyce

doi:10.1148/radiology.13130187

Cited by 27 publications

(37 citation statements)

References 21 publications

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“…Few patients with RA-ILD currently undergo surgical lung biopsy, and HRCT is used primarily to identify the presence of ILD and describe its pattern. ASSAYAG et al [36] found that in RA-ILD, UIP was the dominant histological pattern among patients with rheumatoid arthritis, and UIP on HRCT was 96% specific but only 45% sensitive (with a 53% negative predictive value) for UIP on surgical biopsy; thus, as is the case for patients presenting with an idiopathic interstitial pneumonia, many of the subjects with RA-NSIP in the current study could have had UIP histologic pattern on surgical lung biopsy if one had been done. The key points are these: 1) knowing the HRCT pattern (regardless of the underlying histological pattern) yields important prognostic information; but 2) independent of HRCT pattern (UIP versus NSIP), baseline and change over time in pulmonary physiology variables are strongly associated with prognosis.…”

Section: Discussionmentioning

confidence: 99%

Predictors of mortality in rheumatoid arthritis-associated interstitial lung disease

et al. 2015

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Interstitial lung disease (ILD) is a common pulmonary manifestation of rheumatoid arthritis. There is lack of clarity around predictors of mortality and disease behaviour over time in these patients.We identified rheumatoid arthritis-related interstitial lung disease (RA-ILD) patients evaluated at National Jewish Health (Denver, CO, USA) from 1995 to 2013 whose baseline high-resolution computed tomography (HRCT) scans showed either a nonspecific interstitial pneumonia (NSIP) or a "definite" or "possible" usual interstitial pneumonia (UIP) pattern. We used univariate, multivariate and longitudinal analytical methods to identify clinical predictors of mortality and to model disease behaviour over time.The cohort included 137 subjects; 108 had UIP on HRCT (RA-UIP) and 29 had NSIP on HRCT (RA-NSIP). Those with RA-UIP had a shorter survival time than those with RA-NSIP (log rank p=0.02). In a model controlling for age, sex, smoking and HRCT pattern, a lower baseline % predicted forced vital capacity (FVC % pred) (HR 1.46; p<0.0001) and a 10% decline in FVC % pred from baseline to any time during follow up (HR 2.57; p<0.0001) were independently associated with an increased risk of death.Data from this study suggest that in RA-ILD, disease progression and survival differ between subgroups defined by HRCT pattern; however, when controlling for potentially influential variables, pulmonary physiology, but not HRCT pattern, independently predicts mortality. @ERSpublications In rheumatoid-arthritis associated interstitial lung disease, physiology, and not HRCT pattern, predicts mortality

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Section: Discussionmentioning

confidence: 99%

Predictors of mortality in rheumatoid arthritis-associated interstitial lung disease

et al. 2015

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“…Females are also prone to other autoimmune diseases as well (6,15,27,28). We think that both CTD and CTD-OLD are more frequent in females.…”

Section: Discussionmentioning

confidence: 91%

“…A need for biopsy is further diminished since HRCT results correlate with histopathologic findings. HRCT results have a good correlation with histopathologic patterns (32,33) and the positive predictive value is >90% (15). Additionally, HRCT can be repeated and can be easily compared whereas repeating a biopsy is impractical.…”

Section: Discussionmentioning

confidence: 92%

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Interstitial Lung Diseases in Rheumatology Practice: A Single Center Experience

Erbasan¹,

Öygen²,

Gök³

et al. 2017

Akd Med J

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Objective: Interstitial lung diseases (ILDs) are a heterogeneous group of pulmonary diseases affecting the pulmonary interstitium. ILDs may occur secondary to connective tissue diseases (CTDs) and increase morbidity and mortality due to ventilation impairment. The aim of this study was to reveal the clinical, laboratory and imaging features of CTD-related ILDs (CTD-ILDs) and to analyze the treatment approaches. Material and Methods:A total of 132 consecutive ILD patients were included in this cohort. Demographic characteristics, laboratory and high-resolution chest computed tomography (HRCT) results and treatments were analyzed. results: There were 99 patients with CTD-ILD, the mean age was 54.7±11.6 years, females made up 82.8%, median follow-up time was 48.5 months. There were 96 patients who were followed up for more than six months. The median number of HRCT scans was 3 (1-10) with a median interval of 12.5 months. Most common HRCT findings were ground-glass opacities and interlobular septal thickening. One-third of all scans had a honeycomb pattern. 89.6% of CTD-ILD patients recieved corticosteroids, and 44.8% recieved antimalarials. Azathioprine and cyclophosphamide were the most commonly used immunosuppressive drugs. After treatment, the mean pulmonary function tests did not significantly differ from the baseline (p >0.05). 35% of the patients had improved forced vital capacity (FVC >10% increase) with treatment whereas 31% had decreased values and 34% were stable. conclusion:The desired point of the treatment of CTD-ILD patients has not been reached yet even though a significant effort is being made for the diagnosis, treatment and follow up. Novel curative agents are needed for patients with CTD-ILD.Key Words: Connective tissue diseases, High-resolution computed tomography, Interstitial lung diseases. ÖZAmaç: İnterstitiel akciğer hastalığı(İAH) akciğerlerdeki interstitiel aralığı etkileyen heterojen bir hastalık grubudur. İAH bağ doku hastalıklarına(BDH) sekonder gelişebilir ve solunum yetmezliğinden dolayı sakatlık ve ölüm oranı artar. Bu çalışmanın amacı BDH ilişkili İAH'nın klinik, laboratuvar ve görüntüleme özelliklerini tanımlamak ve tedavi yaklaşımlarını analiz etmektir. Gereç ve Yöntemler:Bu çalışmaya ardışık gelen 132 İAH hastası alındı. Demografik özellikleri, laboratuvar ve yüksek rezolüsyonlu akciğer tomografisi(HRCT) ve tedavi sonuçları analiz edildi. bulgular: BDH ilişkili İAH tanısı alan 99 hasta vardı. Ortalama yaş 54.7±11.6 yıl, kadın oranı %82.8, median takip süresi 48.5 aydı. 96 hastanın takip süresi altı aydan fazlaydı. HRCT taramaları median 12.5 aylık intervaller ile median 3(1-10) kez tekrarlanmıştı. En sık HRCT bulguları buzlu cam opasiteleri ve interlobüler septal kalınlaşmalardır. Hastaların üçte birinde bal peteği paterni vardı. Hastaların %89.6'sı kortikosteroid %44.8'i antimalaryal ajan almıştı. Azatiopürin ve siklofosfamid en sık kullanılan immünosupresif ilaçlardı. Tedavi sonrası ortalama solunum fonksiyon testleri tedavi

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“…In this spectrum of histological and high-resolution computed tomography (HRCT) patterns, UIP represents the fibrotic pole, while the non-UIP pattern represents the inflammatory one. Patients with UIP pattern are older, more frequently male and smokers, and have worst prognosis compared to those with the non-UIP pattern [6][7][8] . The prognosis of patients with RA and UIP pattern mirrors idiopathic pulmonary fibrosis (IPF), with a median survival rate close to three years in both conditions 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Practical Approach to the Evaluation and Management of Rheumatoid Arthritis-Interstitial Lung Disease based on its Proven and Hypothetical Mechanisms

Paulín

Babini

Mamani

et al. 2017

RIC

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The prevalence of interstitial lung disease in patients with rheumatoid arthritis varies from 10 to 42%. Rheumatoid arthritis patients with interstitial lung disease have three times the risk of death compared with those without the disease. Prognosis seems to be related to the high-resolution computed tomography pattern. Usual interstitial pneumonia pattern, resembling idiopathic pulmonary fibrosis, carries a worse prognosis. Validated strategies to identify different phenotypes and assess the disease activity in rheumatoid arthritis interstitial lung disease are lacking. However, the utilization of high-resolution computed tomography, composed disease activity scores, and anti-citrullinated peptide antibodies titers can help to guide decisions in clinical practice. Mechanisms involved in lung disease may be different from those implicated in joint involvement. This could explain why in a significant proportion of cases, interstitial lung disease does not improve or even worsens with standard therapies used successfully to treat the joint component (e.g. anti-tumor necrosis factor agents). In this scenario, a group of drugs that targets the adaptive immune response (e.g. rituximab or abatacept) seems to target more specifically the process that takes place in the lungs. Moreover, the recent emergence of anti-fibrotic drugs, which have already proven effective in idiopathic pulmonary fibrosis, may provide an alternative treatment strategy in rheumatoid arthritis-usual interstitial pneumonia. In this review, we propose a practical approach to the evaluation and therapy of rheumatoid arthritis interstitial lung disease. Validation of strategies directed to assess the activity of lung disease and identify the underlying mechanisms are needed. Clinical trials evaluating a therapeutic approach with specific targets based on the disease phenotype are warranted.

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Rheumatoid Arthritis–associated Interstitial Lung Disease: Radiologic Identification of Usual Interstitial Pneumonia Pattern

Cited by 27 publications

References 21 publications

Predictors of mortality in rheumatoid arthritis-associated interstitial lung disease

Predictors of mortality in rheumatoid arthritis-associated interstitial lung disease

Interstitial Lung Diseases in Rheumatology Practice: A Single Center Experience

Practical Approach to the Evaluation and Management of Rheumatoid Arthritis-Interstitial Lung Disease based on its Proven and Hypothetical Mechanisms

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