Original Research: Diffuse Lung Disease |

Functional Impact of a Spectrum of Interstitial Lung Abnormalities in Rheumatoid ArthritisRheumatoid Arthritis and Interstitial Lung Disease

Tracy J. Doyle, MD, MPH; Paul F. Dellaripa, MD; Kerri Batra, MD; Michelle L. Frits, BA; Christine K. Iannaccone, MPH; Hiroto Hatabu, MD, PhD; Mizuki Nishino, MD; Michael E. Weinblatt, MD; Dana P. Ascherman, MD; George R. Washko, MD, MMSc; Gary M. Hunninghake, MD, MPH; Augustine M. K. Choi, MD; Nancy A. Shadick, MD, MPH; Ivan O. Rosas, MD, FCCP
Author and Funding Information

From the Pulmonary and Critical Care Division (Drs Doyle, Washko, Hunninghake, Choi, and Rosas), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Division of Rheumatology, Immunology and Allergy (Drs Dellaripa, Weinblatt, and Shadick and Mss Frits and Iannaccone), Center for Pulmonary Functional Imaging (Drs Hatabu and Nishino), Department of Radiology (Drs Hatabu and Nishino), and Channing Laboratory (Dr Hunninghake), Brigham and Women’s Hospital, Boston, MA; Division of Rheumatology (Dr Batra), Rhode Island Hospital, Providence RI; Division of Rheumatology (Dr Ascherman), University of Miami Miller School of Medicine, Miami FL; and Lovelace Respiratory Research Institute (Dr Rosas), Albuquerque, NM.

CORRESPONDENCE TO: Ivan O. Rosas, MD, FCCP, Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Thorn 9, Boston, MA 02115; e-mail: irosas@rics.bwh.harvard.edu


FUNDING/SUPPORT: Dr Doyle is supported by the KL2/Catalyst MeRIT Program [Grant 8KL2TR000168-05]. Drs Nishino, Hunninghake, and Rosas are supported by the US National Institutes of Health (NIH) [Grant K23 CA157631 (National Cancer Institute) to Dr Nishino, Grants K08 HL092222 and R01 HL111024 to Dr Hunninghake, and Grant K23 HL087030 to Dr Rosas]. The Brigham and Women’s Hospital Rheumatoid Arthritis Sequential Study is currently sponsored by Crescendo Bioscience Inc, MedImmune LLC, and Bristol-Myers Squibb Co.

Parts of this article have been presented or published in abstract form (17th International Colloquium on Lung & Airway Fibrosis, October 1, 2012, Modena, Italy, and Doyle TJ, Batra K, Frits ML, et al. Am J Resp Crit Care Med. 2013;187[1_MeetingAbstracts]:A22).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2014;146(1):41-50. doi:10.1378/chest.13-1394
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BACKGROUND:  Approximately 10% of patients with rheumatoid arthritis (RA) have interstitial lung disease (ILD), and one-third have subclinical ILD on chest CT scan. In this study, we aimed to further characterize functional decrements in a spectrum of RA-associated ILD.

METHODS:  All subjects were enrolled in the Brigham and Women’s Hospital Rheumatoid Arthritis Sequential Study (BRASS). The presence of interstitial lung abnormalities (ILAs) on clinically indicated chest CT scans was determined using a previously validated sequential reading method. Univariate and multivariate analyses were used to assess the association between degree of ILAs and physiologic, functional, and demographic variables of interest.

RESULTS:  Of 1,145 BRASS subjects, 91 subjects (8%) were included in this study. Twelve had radiologically severe ILAs, 34 had ILAs, and 38 had no ILAs on CT scan. Subjects with radiologically severe ILAs were older (P = .0037), had increased respiratory symptoms (cough, P = .027; dyspnea, P = .010), and more severe RA disease (rheumatoid factor, P = .018; total swollen joints, P = .046) compared with subjects with no ILAs. Participants also had a trend toward having an increased smoking history (P = .16) and having lower FVC % predicted (77% vs 94%, P = .097) and diffusion capacity of carbon monoxide % predicted (52% vs 77%, P = .068). Similar but attenuated increases in respiratory symptoms, functional decrements, and RA disease severity were observed in subjects with ILAs compared with those with no ILAs.

CONCLUSIONS:  We have shown that patients with RA have varying degrees of ILAs that are associated with a spectrum of functional and physiologic decrements. Our findings suggest that improved risk stratification and detection of ILAs will provide a therapeutic window that could improve RA-ILD outcomes.

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