Background/Purpose:

To investigate clinical characteristics of interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients. And to analyze whether high resolutional CT (HRCT) and anti citrullinated peptide antibodies (anti-CCP2) can predict the outcome of ILD in RA.

Methods:

405 patients with RA were treated at our hospital and followed up at least one year as newly onset RA. All patients were performed chest radiological examinations at the initial presentation. The HRCT findings which include (1) ground glass opacity, (2) air-space consolidation, linear opacity including (3) septal line and (4) non-septal line, (5) honeycomb lung, (6) traction bronchiectasis, (7)pleural irregularity, and (8)pleural effusion were scored as the CT scoring system. The extent of involvement of each abnormality was assessed independently for each of the three zones of each lung. The HRCT extent score was represented the sum of the score of each lung. HRCT parameters which include the extension score and the clinical features which include anti-CCP2 at the initial presentation were retrospectively analyzed.

Results:

189 out of 405 patients had abnormal chest radiological findings which included bronchiectasis, bronchitis and ILD (46.7%). 93 (28 male (40.0%), 67 female (22.7%)) out of 405 patients showed ILD at initial presentation (23.0%). 6 out of 93 patients had shortness of breath and showed a rapidly progressive ILD (6.5%). In HRCT findings, ILD in these 6 cases were widely spread at the initial presentation. The rest of 87 patients showed no progression of ILD and asymptomatic (=subclinical ILD). However there were no difference in the HRCT findings which include nonseptal linear attenuation, ground-glass attenuation and air space consolidation between rapidly progressive ILD group and asymptomatic group, rapidly progressive ILD group showed more higher degree in honeycombing (p=0.00018) and extensive ILD (p=0.0068). Higher anti-CCP2 titers were found in higher extensive score of ILD (p=0.0214). Prognosis of the rapidly progressive ILD was variable. The rapidly progressive ILD are treated with immunosuppressive agent which include high dose steroid, cyclophosphamide, azathioprine, cyclosporineA (CsA) and Mycophenolate Mofetil(MMF) for ILD. 2 patients treated with CsA , one with MMF and one with tacrolimus showed improving of ILD on HRCT. But in other 2 patients were resistant to these immunosuppressive agents.

Conclusion:

HRCT findings focused on the extension score at the initial presentation is a useful predictor of the outcome of ILD in RA. Anti-CCP2 is one of the related factor of the extension score. This study suggests that RA patients with preexisting honeycombing lung and extensive ILD must be aware of rapidly progressive ILD which need immunosuppressant.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-characteristics-of-interstitial-lung-disease-ild-in-rheumatoid-arthritis-ra-patients-in-high-resolutional-ct-hrct-and-titer-of-anti-citrullinated-peptide-antibodies-anti-ccp2/