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Screening for preclinical parenchymal lung disease in rheumatoid arthritis

Authors :
Anthony J Esposito
Jeffrey A Sparks
Ritu R Gill
Hiroto Hatabu
Eric J Schmidlin
Partha V Hota
Sergio Poli
Elaine A Fletcher
Wesley Xiong
Michelle L Frits
Christine K Iannaccone
Maria Prado
Alessandra Zaccardelli
Allison Marshall
Paul F Dellaripa
Michael E Weinblatt
Nancy A Shadick
Ivan O Rosas
Tracy J Doyle
Source :
Rheumatology (Oxford)
Publication Year :
2021
Publisher :
Oxford University Press (OUP), 2021.

Abstract

Objectives Pulmonary disease is a common extraarticular manifestation of RA associated with increased morbidity and mortality. No current strategies exist for screening this at-risk population for parenchymal lung disease, including emphysema and interstitial lung disease (ILD). Methods RA patients without a diagnosis of ILD or chronic obstructive pulmonary disease underwent prospective and comprehensive clinical, laboratory, functional and radiological evaluations. High resolution CT (HRCT) scans were scored for preclinical emphysema and preclinical ILD and evaluated for other abnormalities. Results Pulmonary imaging and/or functional abnormalities were identified in 78 (74%) of 106 subjects; 45% had preclinical parenchymal lung disease. These individuals were older with lower diffusion capacity but had similar smoking histories compared with no disease. Preclinical emphysema (36%), the most commonly detected abnormality, was associated with older age, higher anti-cyclic citrullinated peptide antibody titres and diffusion abnormalities. A significant proportion of preclinical emphysema occurred among never smokers (47%) with a predominantly panlobular pattern. Preclinical ILD (15%) was not associated with clinical, laboratory or functional measures. Conclusion We identified a high prevalence of undiagnosed preclinical parenchymal lung disease in RA driven primarily by isolated emphysema, suggesting that it may be a prevalent and previously unrecognized pulmonary manifestation of RA, even among never smokers. As clinical, laboratory and functional evaluations did not adequately identify preclinical parenchymal abnormalities, HRCT may be the most effective screening modality currently available for patients with RA.

Details

ISSN :
14620332 and 14620324
Volume :
61
Database :
OpenAIRE
Journal :
Rheumatology
Accession number :
edsair.doi.dedup.....90ce0bd958e589814984127faa752e47
Full Text :
https://doi.org/10.1093/rheumatology/keab891