Session Type: Abstract Submissions (ACR)
Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a common manifestation of rheumatoid lung disease. Subclinical RA-ILD is most commonly identified on HRCT imaging. In this study, we aimed to define the clinical characteristics of subclinical RA-ILD on HRCT, and to analyze long-term prognosis of subclinical RA-ILD.
340 patients with RA were treated at our hospital and followed them up for three years or until development of symptomatic ILD. 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 included the extension score, ACPA and the clinical features at the initial presentation were retrospectively analyzed.
76 (22.3%) out of 340 RA patients had abnormal chest radiological findings which consist with ILD. 5 out of 76 patients had shortness of breath and showed a rapidly progressive ILD (6.6%). The rest of 71 (48women, 23men) had subclinical RA-ILD who were either asymptomatic or have symptoms and physiologic abnormalities that are as yet unrecognized as being due to RA-ILD. There was no difference in the positive rates of anti-CCP2 between subclinical RA-ILD and clinical evident RA-ILD. However there were no difference in the HRCT findings which included nonseptal linear attenuation, ground-glass attenuation and air space consolidation between subclinical RA-ILD group and clinical RA-ILD group, subclinical RA-ILD group showed less degree in honeycombing (p=0.0003) and focal ILD (p=0.0061). There have only two cases lead to clinically evident RA-ILD within 6 months. These two cases were treated with azathioprine and with MMF showed stable ILD on HRCT.
HRCT finding focused on honeycombing and the extension score at the initial presentation is a sensitive technique for detection of subclinical RA-ILD. This study suggest the progression of asymptomatic radiologic changes could lead to the development of clinical RA-ILD.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-characterization-of-subclinical-rheumatoid-arthritis-associated-interstitial-lung-disease/