Rheumatoid Arthritis Related Interstitial Lung Disease: Patterns of High-resolution Computed Tomography

Rheumatoid arthritis (RA) is considered a systemic inflammatory disease marked by polyarthritis which affects the joints symmetrically, leading to progressive damage of the bone structure and eventually joint deformity. Lung involvement is the most prevalent extra-articular feature of RA, affecting 10–60% of patients with this disease. In this review, we aim to discuss the patterns of RA interstitial lung disease (ILD), the molecular mechanisms involved in the pathogenesis of ILD in RA, and also the therapeutic challenges in this particular extra-articular manifestation. The pathophysiology of RA-ILD has been linked to biomarkers such as anti-citrullinated protein antibodies (ACPAs), MUC5B mutation, Krebs von den Lungen 6 (KL-6), and other environmental factors such as smoking. Patients at the highest risk for RA-ILD and those most likely to advance will be identified using biomarkers. The hope is that finding biomarkers with good performance characteristics would help researchers better understand the pathophysiology of RA-ILD and, in turn, lead to the development of tailored therapeutics for this severe RA manifestation.

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“…DIP is characterized on HRCT by ground-glass opacities, irregular linear opacities, and small cystic spaces [ 84 , 85 ].…”

Section: Diagnosis Of Ra-ildmentioning

confidence: 99%

Novel Biomarkers, Diagnostic and Therapeutic Approach in Rheumatoid Arthritis Interstitial Lung Disease—A Narrative Review

et al. 2022

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“…Of the HRCT scans performed, we found changes in 89.6%, drawing attention to the presence of ILD in 17% of patients. In approximately 57%, we describe the company of other ndings such as image overlap, atelectasis, parenchymal bands, architectural distortion, tree in budding, honeycombing, air trapping and air cysts that coincide with the tomographic changes described in the literature, in addition to a reticular pattern, interlobular septal thickening, ground glass opacities, mosaic perfusion and traction bronchiectasis (20,21). These other ndings, without jointly characterizing a subtype of ILD, are the interstitial lung abnormalities already mentioned in the literature review, described as incidental ndings, present in around 20 to 60% of patients with RA and can progress radiologically in more than 50 % of cses, in less than two years (22).…”

Section: Discussionmentioning

confidence: 87%

Lung involvement in patients with rheumatoid arthritis: a cross-sectional study

Souza,

Alves,

Silva

et al. 2024

JHS

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BackgroundRheumatoid arthritis (RA) is a chronic in ammatory condition primarily characterized by joint pain and swelling. However, it can also affect various organs, including the heart, nervous system, eyes, and lungs. Pulmonary involvement is a signi cant contributor to morbidity and mortality in RA patients, encompassing a spectrum of manifestations such as interstitial lung disease (ILD), bronchiectasis, pleural involvement, and more. ILD can progress to pulmonary brosis, impacting the overall prognosis of RA. MethodsIt is a prospective, analytical, and descriptive cross-sectional study conducted between September 2019 and September 2022 involving RA patients diagnosed according to the 2010 classi cation criteria of the American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR). Structured interviews collected demographic and clinical data, while laboratory tests, HRCT scans, and pulmonary function tests were performed. Disease activity was assessed using DAS-28 and SDAI. ResultsA total of 203 patients were included, predominantly female (88%), with a mean age of 57.14 years. Most patients were non-smokers (74.9%) and exhibited moderate disease activity (35% by DAS-28, 41.1% by SDAI). Nearly half of the sample had antibodies, with 47.5% positive for RF and 48.5% for Anti-CCP. HRCT revealed abnormalities in 89.6% of patients, with ILD present in 17% and pulmonary brosis in 6.5%. RF was associated with ILD and small airway involvement, while male gender correlated with emphysema and small airway involvement. ConclusionsPulmonary involvement, assessed via HRCT, was highly prevalent in RA patients, even those without respiratory symptoms. These ndings underscore the importance of early pulmonary evaluation during RA, as well as the need for monitoring and managing pulmonary manifestations, particularly in patients with speci c risk factors such as male gender, advanced age, and positive antibodies. BACKGROUNDRheumatoid arthritis (RA) is a chronic in ammatory disease characterized by joint pain and swelling. Despite the predominance of joint involvement, RA is a multisystem disease with an autoimmune background, which can affect several organs and systems, such as the heart, the nervous system, the eyes, and the lungs, among others(1, 2).Lung involvement is a signi cant cause of morbidity and mortality. Manifestations can be varied and sometimes do not result in signi cant symptoms. However, they can represent different conditions, from interstitial in ltrates, bronchiectasis, and bronchiolitis, pleural involvement, presence of rheumatoid nodules in the lungs, diseases of the vascular bed, pulmonary toxicity due to the medicinal effect of drugs used to treat the condition, and even secondary infectious processes(3).Interstitial lung disease (ILD) is the most prevalent manifestation, and some cases can progress to pulmonary brosis and, consequently, respiratory failure, affecting the prognosis with an autoimmune background, which can affect several organs and systems, such as...

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“…La DIP se caracteriza en la TCAR por opacidades en vidrio esmerilado, opacidades lineales irregulares y pequeños espacios quísticos [84, 85].…”

Section: Diagnóstico De La Ar-epiunclassified

Nuevos biomarcadores y enfoques diagnósticos y terapéuticos en la enfermedad pulmonar intersticial por artritis reumatoide: una revisión narrativa

et al. 2022

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La artritis reumatoide (AR) se considera una enfermedad inflamatoria sistémica, caracterizada por una poliartritis que afecta a las articulaciones de forma simétrica, lo que provoca daño progresivo en la estructura ósea y, finalmente, deformidad articular. La afectación pulmonar es la característica extraarticular más prevalente de la AR, y afecta a 10-60% de los pacientes con la enfermedad. En esta revisión discutimos los patrones de la enfermedad pulmonar intersticial (EPI) de la AR, los mecanismos moleculares implicados en la patogénesis de la EPI en la AR, y también los retos terapéuticos en esta particular manifestación extraarticular. La fisiopatología de la AR-EPI se ha relacionado con biomarcadores como los anticuerpos contra proteínas citrulinadas (ACPAs), mutación en MUC5B, los niveles de Krebs von den Lungen 6 (KL-6) y factores ambientales como el tabaquismo. Los pacientes con mayor riesgo de padecer RA-EPI y quienes tengan más probabilidades de evolucionar se identificarán mediante biomarcadores. Se espera que el hallazgo de biomarcadores con buenas características de desempeño ayude a los investigadores a comprender mejor la fisiopatología de la AR-EPI y, a su vez, conduzca al desarrollo de terapias personaliza<X00_Del_TrennDivis>-</X00_Del_TrennDivis>das para esta grave manifestación de la AR.

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Rheumatoid Arthritis Related Interstitial Lung Disease: Patterns of High-resolution Computed Tomography

Cited by 7 publications

References 20 publications

Novel Biomarkers, Diagnostic and Therapeutic Approach in Rheumatoid Arthritis Interstitial Lung Disease—A Narrative Review

Novel Biomarkers, Diagnostic and Therapeutic Approach in Rheumatoid Arthritis Interstitial Lung Disease—A Narrative Review

Lung involvement in patients with rheumatoid arthritis: a cross-sectional study

Nuevos biomarcadores y enfoques diagnósticos y terapéuticos en la enfermedad pulmonar intersticial por artritis reumatoide: una revisión narrativa

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