Background/Purpose: Using of high-resolution computed tomography(HRCT) has increased the early detection of interstitial lung disease(ILD) in asymptomatic and undiagnosed individuals. This study was to identify asymptomatic lung disease and to analyze long-term prognosis of subclinical rheumatoid arthritis-associated ILD(RA-ILD).

Methods: 1502 patients with RA were treated and followed them up for seven 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.

Results: 92(6.1%) out of 1,502 RA patients had abnormal chest radiological findings which consist with ILD. 5 out of 92 patients had shortness of breath and showed a rapidly progressive ILD (5.4%) at the presentation. The rest of 87 (54women, 33men) 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 at the presentation. 12(13.8%) out of 87 subclinical RA-ILD patients developed symptomatic RA-ILD after diagnosed RA (28.4+/-16.1 months). There was no difference in the positive rates of anti-CCP2 and HRCT findings at the presentation between stable subclinical RA-ILD and later-developing clinical RA-ILD. However there was a difference in the HRCT finding which showed progression of ground-glass attenuation (HRCT score 2.1+/-0.7 vs. 0.1+/-0.3, p<0.001). These 12 cases were treated with immunosuppressant which include tacrolimus, azathioprine and MMF. And all cases showed stable ILD on HRCT after treatment of immunosuppressant.

Conclusion: Subclinical RA-ILD,which is detectable on HRCT, should be considered in RA even in absence of chest symptoms. HRCT finding focused on progression of ground-glass attenuation is a sensitive technique for detection of later-developing clinical RA-ILD in subclinical group.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-follow-up-of-subclinical-interstitial-lung-disease-in-rheumatoid-arthritis/