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Predictive factors of mortality in rheumatoid arthritis-associated interstitial lung disease analysed by modified HRCT classification of idiopathic pulmonary fibrosis according to the 2018 ATS/ERS/JRS/ALAT criteria.
J Thorac Dis. 2019 Dec; 11(12):5247-5257.JT

Abstract

Background

Interstitial lung disease (ILD) is associated with high morbidity and mortality in rheumatoid arthritis (RA). Although usual interstitial pneumonia (UIP) pattern was reported as a poor prognostic factor, in clinical practice, we often cannot classify high-resolution computed tomography (HRCT) patterns specifically as UIP or nonspecific interstitial pneumonia (NSIP). This study of RA-ILD aimed to elucidate prognosis by using our modified HRCT pattern classification according to the latest guideline on idiopathic pulmonary fibrosis (IPF).

Methods

We analysed the medical records of 96 consecutive patients diagnosed as having RA-ILD. The modified HRCT classifications were defined as definite UIP, probable UIP, indeterminate for UIP (i.e., early UIP or NSIP/UIP), NSIP, organizing pneumonia (OP), NSIP+OP, and unclassifiable. Predictors of prognosis were determined using Cox regression models.

Results

Our RA-ILD cohort included definite UIP (21%), probable UIP (20%), indeterminate for UIP (30%) including NSIP/UIP (27%), alternative diagnosis (29%) including NSIP (14%), and other patterns. Interrater agreement for HRCT pattern was good (κ=0.75). Multivariate analysis showed that older age, history of acute exacerbation, and radiological honeycombing were negative prognostic factors of mortality.

Conclusions

NSIP/UIP pattern of indeterminate for UIP was the major pattern in RA-ILD. Although classifications of HRCT patterns were not related to survival, the presence of radiological honeycombing could be a useful predictor of poor prognosis, and acute exacerbation of ILD can seriously impact patient survival regardless of the presence of a UIP or indeterminate for UIP pattern. Our modified HRCT classification based on the latest IPF guideline might be useful to assess appropriate strategies of diagnosis in future RA-ILD studies, and radiological honeycombing could better predict poor prognosis rather than HRCT pattern.

Authors+Show Affiliations

Department of Respiratory Medicine, 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, Saitama, Japan.Department of Respiratory Medicine, 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, Saitama, Japan.Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan.Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, 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, Saitama, Japan.Department of Respiratory Medicine, 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, Saitama, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32030242

Citation

Yamakawa, Hideaki, et al. "Predictive Factors of Mortality in Rheumatoid Arthritis-associated Interstitial Lung Disease Analysed By Modified HRCT Classification of Idiopathic Pulmonary Fibrosis According to the 2018 ATS/ERS/JRS/ALAT Criteria." Journal of Thoracic Disease, vol. 11, no. 12, 2019, pp. 5247-5257.
Yamakawa H, Sato S, Tsumiyama E, et al. Predictive factors of mortality in rheumatoid arthritis-associated interstitial lung disease analysed by modified HRCT classification of idiopathic pulmonary fibrosis according to the 2018 ATS/ERS/JRS/ALAT criteria. Journal of thoracic disease. 2019;11(12):5247-5257.
Yamakawa, H., Sato, S., Tsumiyama, E., Nishizawa, T., Kawabe, R., Oba, T., Kamikawa, T., Horikoshi, M., Akasaka, K., Amano, M., Kuwano, K., & Matsushima, H. (2019). Predictive factors of mortality in rheumatoid arthritis-associated interstitial lung disease analysed by modified HRCT classification of idiopathic pulmonary fibrosis according to the 2018 ATS/ERS/JRS/ALAT criteria. Journal of Thoracic Disease, 11(12), 5247-5257. https://doi.org/10.21037/jtd.2019.11.73
Yamakawa H, et al. Predictive Factors of Mortality in Rheumatoid Arthritis-associated Interstitial Lung Disease Analysed By Modified HRCT Classification of Idiopathic Pulmonary Fibrosis According to the 2018 ATS/ERS/JRS/ALAT Criteria. Journal of thoracic disease. 2019;11(12):5247-5257. PubMed PMID: 32030242.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictive factors of mortality in rheumatoid arthritis-associated interstitial lung disease analysed by modified HRCT classification of idiopathic pulmonary fibrosis according to the 2018 ATS/ERS/JRS/ALAT criteria. AU - Yamakawa,Hideaki, AU - Sato,Shintaro, AU - Tsumiyama,Emiri, AU - Nishizawa,Tomotaka, AU - Kawabe,Rie, AU - Oba,Tomohiro, AU - Kamikawa,Teppei, AU - Horikoshi,Masanobu, AU - Akasaka,Keiichi, AU - Amano,Masako, AU - Kuwano,Kazuyoshi, AU - Matsushima,Hidekazu, PY - 2020/2/8/entrez PY - 2020/2/8/pubmed PY - 2020/2/8/medline KW - Honeycombing KW - interstitial lung disease (ILD) KW - prognosis KW - radiological pattern KW - rheumatoid arthritis (RA) SP - 5247 EP - 5257 JF - Journal of thoracic disease VL - 11 IS - 12 N2 - Background: Interstitial lung disease (ILD) is associated with high morbidity and mortality in rheumatoid arthritis (RA). Although usual interstitial pneumonia (UIP) pattern was reported as a poor prognostic factor, in clinical practice, we often cannot classify high-resolution computed tomography (HRCT) patterns specifically as UIP or nonspecific interstitial pneumonia (NSIP). This study of RA-ILD aimed to elucidate prognosis by using our modified HRCT pattern classification according to the latest guideline on idiopathic pulmonary fibrosis (IPF). Methods: We analysed the medical records of 96 consecutive patients diagnosed as having RA-ILD. The modified HRCT classifications were defined as definite UIP, probable UIP, indeterminate for UIP (i.e., early UIP or NSIP/UIP), NSIP, organizing pneumonia (OP), NSIP+OP, and unclassifiable. Predictors of prognosis were determined using Cox regression models. Results: Our RA-ILD cohort included definite UIP (21%), probable UIP (20%), indeterminate for UIP (30%) including NSIP/UIP (27%), alternative diagnosis (29%) including NSIP (14%), and other patterns. Interrater agreement for HRCT pattern was good (κ=0.75). Multivariate analysis showed that older age, history of acute exacerbation, and radiological honeycombing were negative prognostic factors of mortality. Conclusions: NSIP/UIP pattern of indeterminate for UIP was the major pattern in RA-ILD. Although classifications of HRCT patterns were not related to survival, the presence of radiological honeycombing could be a useful predictor of poor prognosis, and acute exacerbation of ILD can seriously impact patient survival regardless of the presence of a UIP or indeterminate for UIP pattern. Our modified HRCT classification based on the latest IPF guideline might be useful to assess appropriate strategies of diagnosis in future RA-ILD studies, and radiological honeycombing could better predict poor prognosis rather than HRCT pattern. SN - 2072-1439 UR - https://www.unboundmedicine.com/medline/citation/32030242/Predictive_factors_of_mortality_in_rheumatoid_arthritis_associated_interstitial_lung_disease_analysed_by_modified_HRCT_classification_of_idiopathic_pulmonary_fibrosis_according_to_the_2018_ATS/ERS/JRS/ALAT_criteria_ L2 - https://doi.org/10.21037/jtd.2019.11.73 DB - PRIME DP - Unbound Medicine ER -
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