Chest
Volume 127, Issue 6, June 2005, Pages 2019-2027
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Clinical Investigations
Histopathologic Pattern and Clinical Features of Rheumatoid Arthritis-Associated Interstitial Lung Disease

https://doi.org/10.1378/chest.127.6.2019Get rights and content

Study objectives

To investigate the histopathologic pattern and clinical features of patients with rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) according to the American Thoracic Society (ATS)/European Respiratory Society consensus classification of idiopathic interstitial pneumonia.

Design

Retrospective review.

Setting

Two thousand-bed, university-affiliated, tertiary referral center.

Patients

Eighteen patients with RA who underwent surgical lung biopsy (SLBx) for suspected ILD.

Method

SLBx specimens were reviewed and reclassified by three lung pathologists according to the ATS/European Respiratory Society classification. Clinical features and follow-up courses for the usual interstitial pneumonia (UIP) pattern and the nonspecific interstitial pneumonia (NSIP) pattern were compared.

Results

The histopathologic patterns were diverse: 10 patients with the UIP pattern, 6 patients with the NSIP pattern, and 2 patients with inflammatory airway disease with the organizing pneumonia pattern. RA preceded ILD in the majority of patients (n = 12). In three patients, ILD preceded RA; in three patients, both conditions were diagnosed simultaneously. The majority (n = 13) of patients had a restrictive defect with or without low diffusion capacity of the lung for carbon monoxide (Dlco) on pulmonary function testing; 2 patients had only low Dlco. The UIP and NSIP groups were significantly different in their male/female ratios (8/2 vs 0/6, respectively; p = 0.007) and smoking history (current/former or nonsmokers, 8/2 vs 0/6; p = 0.007). Many of the patients with the UIP pattern had typical high-resolution CT features of UIP. Five patients with the UIP pattern died, whereas no deaths occurred among patients with the NSIP pattern during median follow-up durations of 4.2 years and 3.7 years, respectively.

Conclusions

The histopathologic type of RA-ILD was diverse; in our study population, the UIP pattern seemed to be more prevalent than the NSIP pattern.

Section snippets

Patients

This is a retrospective study performed at Asan Medical Center, a 2,000-bed, university-affiliated, tertiary referral center in Seoul, Korea. A computer-aided search revealed 42 patients with an RA-ILD diagnosis from January 1991 to November 2002; 18 of these patients underwent SLBx. We have had a policy of performing SLBx on all patients with clinically significant diffuse lung diseases to get a definitive diagnosis. The major reason we could not perform the SLBx was that patients refused to

Histologic Diagnosis

The κ coefficient of agreement between the pathologists (M.K. and T.V.C. for example) for the differentiation of UIP and NSIP patterns was 0.63. The most frequent histopathologic pattern was UIP (55.6%) [Table 1; Fig 1]. The NSIP pattern was found in six patients (mixed cellular and fibrotic NSIP in two patients, fibrotic NSIP in four patients) [Fig 2], and inflammatory airway disease (IAD) combined with an organizing pneumonia (OP) pattern were seen in two patients. One patient with IAD

Discussion

This study shows that the distribution of histopathologic patterns in RA-ILD was different than in other types of CVD-ILD, with the UIP pattern being more prevalent than NSIP pattern. We also found that IAD was one of important manifestations in RA patents, as reported in previous studies.14151617 Death occurred only in the UIP group, and all patients with NSIP were alive and improved or stable in this small series.

Our finding of a more prevalent UIP pattern in RA compared to the NSIP pattern

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