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Impact of radiological honeycombing in rheumatoid arthritis-associated interstitial lung disease.
BMC Pulm Med. 2020 Jan 30; 20(1):25.BP

Abstract

BACKGROUND

Interstitial lung disease (ILD) is the most common and important pulmonary manifestation of rheumatoid arthritis (RA). A radiological honeycomb pattern has been described in diverse forms of ILD that can impact survival. However, the clinical course and sequential radiological changes in the formation of the honeycomb pattern in patients with RA-ILD is not fully understood.

METHODS

We evaluated the sequential changes in computed tomography findings in 40 patients with chronic forms of RA-ILD without the honeycomb pattern at initial diagnosis. We classified the patients into the Non-honeycomb group and Honeycomb group, and then analyzed the characteristics and prognosis of the two groups. The term "honeycomb formation" indicated a positive finding of honeycombing on any available follow-up CT.

RESULTS

Our RA-ILD cohort included patients with probable usual interstitial pneumonia (UIP) (35%), nonspecific interstitial pneumonia (NSIP) (20%), and mixed NSIP/UIP (45%). Among all RA-ILD patients, 16 (40%) showed honeycomb formation on follow-up CT (median time between initial and last follow-up CT was 4.7 years). Patient characteristics and prognosis were not significantly different between the Non-honeycomb and Honeycomb groups. However, Kaplan-Meier survival curve for the time from the date of honeycomb formation to death showed a poor median survival time of 3.2 years.

CONCLUSIONS

A certain number of patients with RA-ILD developed a honeycomb pattern during long-term follow-up, regardless of whether they had UIP or NSIP. Prognosis in the patients with characteristics of both progressive ILD and honeycomb formation could be poor. Although radiological findings over the disease course and clinical disease behavior in RA-ILD are heterogenous, clinicians should be alert to the possibility of progressive disease and poor prognosis in patients with RA-ILD who form a honeycomb pattern during follow-up observation.

Authors+Show Affiliations

Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan. hide1144@jikei.ac.jp. Department of Internal Medicine, Division of Respiratory Medicine, Jikei University School of Medicine, Tokyo, Japan. hide1144@jikei.ac.jp.Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan.Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan.Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan.Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan.Department of Rheumatology, Saitama Red Cross Hospital, Saitama, Japan.Department of Rheumatology, Saitama Red Cross Hospital, Saitama, Japan.Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan.Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan.Department of Radiology, Saitama Red Cross Hospital, Saitama, Japan.Department of Internal Medicine, Division of Respiratory Medicine, Jikei University School of Medicine, Tokyo, Japan.Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32000736

Citation

Yamakawa, Hideaki, et al. "Impact of Radiological Honeycombing in Rheumatoid Arthritis-associated Interstitial Lung Disease." BMC Pulmonary Medicine, vol. 20, no. 1, 2020, p. 25.
Yamakawa H, Sato S, Nishizawa T, et al. Impact of radiological honeycombing in rheumatoid arthritis-associated interstitial lung disease. BMC Pulm Med. 2020;20(1):25.
Yamakawa, H., Sato, S., Nishizawa, T., Kawabe, R., Oba, T., Kato, A., Horikoshi, M., Akasaka, K., Amano, M., Sasaki, H., Kuwano, K., & Matsushima, H. (2020). Impact of radiological honeycombing in rheumatoid arthritis-associated interstitial lung disease. BMC Pulmonary Medicine, 20(1), 25. https://doi.org/10.1186/s12890-020-1061-x
Yamakawa H, et al. Impact of Radiological Honeycombing in Rheumatoid Arthritis-associated Interstitial Lung Disease. BMC Pulm Med. 2020 Jan 30;20(1):25. PubMed PMID: 32000736.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of radiological honeycombing in rheumatoid arthritis-associated interstitial lung disease. AU - Yamakawa,Hideaki, AU - Sato,Shintaro, AU - Nishizawa,Tomotaka, AU - Kawabe,Rie, AU - Oba,Tomohiro, AU - Kato,Akari, AU - Horikoshi,Masanobu, AU - Akasaka,Keiichi, AU - Amano,Masako, AU - Sasaki,Hiroki, AU - Kuwano,Kazuyoshi, AU - Matsushima,Hidekazu, Y1 - 2020/01/30/ PY - 2020/01/08/received PY - 2020/01/23/accepted PY - 2020/2/1/entrez PY - 2020/2/1/pubmed PY - 2020/11/28/medline KW - Honeycombing KW - Interstitial lung disease KW - Prognosis KW - Rheumatoid arthritis KW - Time course SP - 25 EP - 25 JF - BMC pulmonary medicine JO - BMC Pulm Med VL - 20 IS - 1 N2 - BACKGROUND: Interstitial lung disease (ILD) is the most common and important pulmonary manifestation of rheumatoid arthritis (RA). A radiological honeycomb pattern has been described in diverse forms of ILD that can impact survival. However, the clinical course and sequential radiological changes in the formation of the honeycomb pattern in patients with RA-ILD is not fully understood. METHODS: We evaluated the sequential changes in computed tomography findings in 40 patients with chronic forms of RA-ILD without the honeycomb pattern at initial diagnosis. We classified the patients into the Non-honeycomb group and Honeycomb group, and then analyzed the characteristics and prognosis of the two groups. The term "honeycomb formation" indicated a positive finding of honeycombing on any available follow-up CT. RESULTS: Our RA-ILD cohort included patients with probable usual interstitial pneumonia (UIP) (35%), nonspecific interstitial pneumonia (NSIP) (20%), and mixed NSIP/UIP (45%). Among all RA-ILD patients, 16 (40%) showed honeycomb formation on follow-up CT (median time between initial and last follow-up CT was 4.7 years). Patient characteristics and prognosis were not significantly different between the Non-honeycomb and Honeycomb groups. However, Kaplan-Meier survival curve for the time from the date of honeycomb formation to death showed a poor median survival time of 3.2 years. CONCLUSIONS: A certain number of patients with RA-ILD developed a honeycomb pattern during long-term follow-up, regardless of whether they had UIP or NSIP. Prognosis in the patients with characteristics of both progressive ILD and honeycomb formation could be poor. Although radiological findings over the disease course and clinical disease behavior in RA-ILD are heterogenous, clinicians should be alert to the possibility of progressive disease and poor prognosis in patients with RA-ILD who form a honeycomb pattern during follow-up observation. SN - 1471-2466 UR - https://www.unboundmedicine.com/medline/citation/32000736/Impact_of_radiological_honeycombing_in_rheumatoid_arthritis_associated_interstitial_lung_disease_ DB - PRIME DP - Unbound Medicine ER -