Session Information
Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality
Session Type: Abstract Submissions (ACR)
Background/Purpose: Early detection and treatment of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) may ameliorate disease progression. The objective of the present study was to: 1) study the frequency of asymptomatic preclinical ILD in early RA patients, in order to determine how early the lungs are affected in the disease and establish whether it is clinically advantageous to systematically screen asymptomatic patients for this complication; and 2) study the potential association of anti-citrullinated peptide antibody (ACPA) positivity with RA-ILD
Methods: Observational prospective study of a cohort of early RA patients (joint symptoms < 2 years) who did not present respiratory symptoms and were included in an ILD screening program via baseline chest radiograph and complete pulmonary function tests (PFT). In patients with lung abnormalities in the chest radiograph or any restriction or impaired diffusion, defined as < 80% of predicted forced vital capacity (FVC) and diffusing lung capacity for carbon monoxide (DLCO) respectively, the study was completed with a high-resolution computerized tomography scan (HRCT) of the chest.
Results: Forty patients (30 women) were included in the study, with PFR alterations detected in 18 (45%). All cases had a DLCO < 80% of predicted (mean 68%; range 43% to 78%), without significant reduction in the FVC values. The HRCT detected abnormalities in only 7 of these 18 patients: 1 radiographic pattern suggestive of non-specific interstitial pneumonia (NSIP); 1 radiographic pattern of respiratory bronchiolitis-associated interstitial lung disease (RB-ILD); the other 5 had bronchiectasis in the absence of fibrosis, emphysema or pulmonary nodules. In 11 patients with DLCO alterations, the HRCT was normal, and in none of these cases could the alteration be attributed to the presence of anemia.
A significant inverse correlation between ACPA levels and baseline DLCO was found. We also observed, a significant association between the severity of disease activity as measured by DAS28-CRP and baseline DLCO values.
Conclusion: Asymptomatic preclinical ILD, which is detectable by restrictive abnormalities in PFT (mainly, DLCO < 80% of predicted), is common (45%) among patients with early RA. PFT screening may be indicated for such patients since early detection of these alterations could change the course of the lung disease if risk factors (such as smoking or environmental exposures) are avoided, infections are prevented and drugs for RA treatment are selected that are less harmful to the lung. Our data also support a relationship between high ACPA levels and the occurrence of RA-ILD.
Disclosure:
J. Narváez,
None;
A. Robles Perez,
None;
M. Molina Molina,
None;
J. M. Nolla,
None.
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