Pulmonary Abnormalities Observed in 70% of Patients With RA in Study

Pulmonary abnormalities have a significant presence in patients with rheumatoid arthritis (RA), found researchers of a recent study, which also showed that these pulmonary abnormalities evolved in several patterns—not at random.

Though typically associated with effects on the joints, RA was found have a pulmonary effect in nearly 3 in 4 patients included in the retrospective, single-center study.

“RA affects not just the joints but also numerous other organs, including the lungs,” explained the researchers.“Pulmonary involvement contributes substantially to the morbidity and mortality of patients with RA. The occurrence of pulmonary abnormalities restricts RA treatment. Thus, the management of pulmonary involvement in RA and the treatment of RA in patients with pulmonary abnormalities are important.”

The researchers studied data from more than 200 patients, with 70% exhibiting pulmonary abnormalities. More than half of patients had airway disease (AD) and 38.9% had interstitial lung disease (ILD), the most common of which was appearance of reticular patterns.

The data showed that many patients had more than 1 pulmonary abnormality, which led the researchers to perform a cluster analysis to characterize co-occurrence patterns. The analysis revealed that the majority of patients had AD, present in 79% of patients with any pulmonary abnormality, 77% of patients with ILD, and 71% of patients with nodular lesions. At the individual level, AD was associated with ILD and nodular lesions.

Based on these findings, the researchers suggest that AD may be have a role in the development and exacerbation of pulmonary abnormalities. The group underscored the importance of larger, prospective, multicenter studies to determine the developmental pathway of pulmonary abnormalities on the disease.

Throughout the mean 3 years of follow-up, over 170 pulmonary abnormalities from 90 patients changed, with 115 newly emerging abnormalities, 42 worsening abnormalities, including bronchiolitis (n = 9), bronchiectasis (n=8), and reticular patterns (n = 6). Throughout follow-up, there were 25 abnormalities that improved, including bronchiolitis (n = 5), GGO (n = 3), and consolidation (n = 3).

“We found several associations between pre-existing and new or worsening lung abnormalities at the cluster and individual abnormality levels. New GGOs were correlated with pre-existing AD, small nodular pattern, and honeycombing. It is well known that usual interstitial pneumonia (UIP), characterized by honeycombing, is a risk factor for acute exacerbation and the emergence of new GGO, which is consistent with our findings. However, the relationshipbetween new GGO and pre-existing AD or small nodules was a novel finding. Additionally, new interlobular septal thickening was also associated with pre-existing bronchiolitis. These relationships may suggest an association between pre-existing AD and new ILD.”

The researchers noted that the associations observed between pre-existing and changing pulmonary abnormalities may not be conclusive because timing of follow-up scans varied based on physician.

Reference

Tanaka A, Kurasawa K, Soda S, et al. Changing patterns of pulmonary abnormalities in rheumatoid arthritis. Respir Investig. Published online October 4, 2022. doi:10.1016/j.resinv.2022.09.002