Background/Purpose: Use of biological therapy (BT) has dramatically improved Rheumatoid Arthritis (RA) management and outcomes for the last decade. Classic extraarticular manifestations are now uncommon, excepting for pulmonary involvement, which may be due to different factors and may itself affect also treatment election and patient prognosis. The aim of this study is to evaluate the presence of pulmonary complications in RA patients under BT in our hospital, assess its severity and related changes in treatment.

Methods: Review of clinical records of 208 RA patients receiving BT in the last 5 years (January 2012 to December 2016). 23 cases of preexisting lung disease for other causes (asthma, smoking) have been excluded. We collected demographic data, characteristics of RA, types of pulmonary involvement, followup and changes in treatment of 26 patients finally included. Statistical analysis were performed using SPSS v22.

Results:

73.1% were women, mean aged 59 years (31-80); 53.8% were never smokers. They suffered from longstanding RA yet (median 176.92 months, SD 199.34); only 2 patients were early arthritis (RA diagnose during the previous year). 85% were RF positive with positive CCP antibodies in 69.2%, and structural damage with erosions was present in 70%. Other extraarticular manifestations (3 patients with rheumatoid nodules, 4 with cardiac involvement) were present in 25% .

At the time of lung disease diagnosis, 1/2 patients were in remission or low activity (DAS 28), with a median CRP 0.52 mg/dL (SD 1.72). 90% had received methotrexate and almost half of them leflunomide; 30% had been previously treated with BT (50% TNF alpha inhibitors). Interstitial lung disease (ILD) was the most frequent pulmonary involvement (57.7%) and non-specific intersticial pheumonia (NSIP) the most prevalent pattern (> 60%). We also found obstructive pulmonary disease (11.5%) and vascular involvement (7.7%). Gold standard image diagnostic technique was high resolution CT (40% presented a normal X-ray)

Treatment was modified in 53.8% of the cases (synthetic DMARD was kept in 68% and BT in 64%).

The average followup of pulmonary involvement was 37.85 months (1-156). 80% of the patients kept stable or improved from their arthritis and also from respiratory disease. Only one patient received a lung trasplant and another one died.

We haven´t found association between different types of pulmonary involvement and the different variables analyzed in the study. We did´t show significant differences in prognosis related to pulmonary disease distinct patterns; up to 80% of patients with ILD stabilize or improve

Conclusion: Prevalence of pulmonary disease in our experience in RA patients under BT is similar to prevalence in other observational studies (10-20%), diagnosis here was made for a casual detection in a routine chest X-ray or for clinical suspicion for respiratory symptoms (cough, dyspnea…). Pulmonary involvement evolution here has been good perhaps for the high prevalence of NSIP, which is also thought to require less therapeutic intervention. Protocols for search and management of lung disease in RA patients are an unmet need in clinical practice, and its pathogenesis and treatment are important fields for translational and clinical research.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/pulmonary-involvement-in-our-patients-with-rheumatoid-arthritis-under-biological-therapy-a-tertiary-hospital-experience/