Baseline Characteristics and Progression of a Spectrum of Interstitial Lung Abnormalities and Disease in Rheumatoid Arthritis.

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Interstitial lung abnormalities (ILA) and interstitial lung disease (ILD) are seen in up to 60% of individuals with rheumatoid arthritis (RA), some of which will progress to have a significant impact on morbidity and mortality. Better characterization of progressive interstitial changes and identification of risk factors associated with progression may enable earlier intervention and improved outcomes.what are baseline characteristics associated with RA-ILD progression?and Methods: Retrospective study where all clinically-indicated computed tomography (CT) chest scans in adult RA subjects from 2014-16 were evaluated for interstitial changes and further subdivided into ILA and ILD based on clinical record review. Progression was determined visually and subsequently semi-quantified.Those with a spectrum of interstitial changes (64 out of 293) were older male smokers and less likely on biologics/small molecule disease-modifying anti-rheumatic drugs. Of 44% with ILA, 46% had chest CTs performed for non-pulmonary indications. Of the 56 ILA/ILD with sequential CTs, 38% had evidence of radiologic progression over 4.4 years; 29% of ILA progressed. Risk factors for progressive ILA/ILD included a subpleural distribution and higher baseline involvement.Of 293 RA subjects with clinically-indicated CTs, interstitial changes were observed in 22%, half of whom had a respiratory complaint at the time of imaging; radiologic progression was seen in 38%. Of individuals with progressive ILA, half had baseline CTs performed for non-pulmonary indications. Subpleural distribution and higher baseline ILA/ILD extent were risk factors associated with progression. Prospective longitudinal studies of RA-ILA are necessary.


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