Elsevier

Respiratory Medicine

Volume 134, January 2018, Pages 24-30
Respiratory Medicine

Several high-resolution computed tomography findings associate with survival and clinical features in rheumatoid arthritis-associated interstitial lung disease

https://doi.org/10.1016/j.rmed.2017.11.013Get rights and content
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Highlights

  • The extent of reticulation associate with shorter survival in patients with RA-ILD.

  • The extent of traction bronchiectasis also associates with worse survival.

  • It also correlates with hospitalizations due to respiratory reasons.

  • The extent of honeycombing also correlates with respiratory hospitalizations.

  • Many HRCT findings can be useful when assessing the risk of death in RA-ILD.

Abstract

Objective

To compare the presence and extent of several high-resolution computed tomography (HRCT) observations in different subtypes of rheumatoid arthritis-related interstitial lung disease (RA-ILD) and to examine associations between radiological findings, hospitalization, age, RA duration, pulmonary function tests (PFT) and survival.

Materials and methods

HRCTs from 60 RA-ILD patients were independently evaluated and re-categorized into usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), organizing pneumonia (OP), diffuse alveolar damage (DAD) and unclassified subtypes by two radiologists. The presence and extent, which was reported using a semi-quantitative scoring system, of e.g. reticulation, ground-glass opacity, honeycombing, emphysema, traction bronchiectasis and architectural distortion were further evaluated and compared between the subtypes. Associations between radiological findings and survival were identified with the Kaplan-Meier method and Cox's univariate model. The correlations between radiological findings, hospitalization, age, pack years, RA duration and PFT were calculated using Spearman's correlation coefficient.

Results

The extents of reticulation (HR 1.144, p = 0.041), traction bronchiectasis (HR 1.184, p = 0.030), architectural distortion (HR 1.094, p = 0.044) and the presence of pleural fluid (HR 14.969, p < 0.001) were associated with decreased survival. A negative correlation was observed between ground-glass opacity (GGO) and the duration of RA (r = −0.308, p = 0.023). The extents of honeycombing (r = 0.266, p = 0.046), traction bronchiectasis (r = 0.333, p = 0.012) and architectural distortion (r = 0.353, p = 0.007) correlated with hospitalizations due to respiratory reasons.

Conclusions

Many radiological findings associate with the course of the disease of RA-ILD and could potentially be useful when planning the RA treatment or evaluating the risk of death in these patients.

Keywords

Rheumatoid arthritis
Interstitial lung diseases
High-resolution computed tomography
Survival

Abbreviations

ANA
antinuclear antibodies
CTD
connective tissue diseases
DAD
diffuse alveolar damage
DLCO
diffusion capacity to carbon monoxide
FEV1
forced expiratory volume
FVC
forced vital capacity
GGO
ground-glass opacity
HRCT
high-resolution computed tomography
IIP
idiopathic interstitial pneumonias
ILD
interstitial lung disease
IPF
idiopathic pulmonary fibrosis
KUH
Kuopio University Hospital
MTX
methotrexate
NSIP
nonspecific interstitial pneumonia
OP
organizing pneumonia
PFT
pulmonary function tests
RA
rheumatoid arthritis
RA-ILD
rheumatoid arthritis-associated interstitial lung disease
RF
rheumatoid factor
UIP
usual interstitial pneumonia

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