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Histopathologic pattern and clinical features of rheumatoid arthritis-associated interstitial lung disease Lee HK; Kim DS; Yoo B; Seo JB; Rho JY; Colby TV; Kitaichi MChest 2005[Jun]; 127 (6): 2019-27STUDY 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 (D(LCO)) on pulmonary function testing; 2 patients had only low (D(LCO)). 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.|Adult[MESH]|Aged[MESH]|Arthritis, Rheumatoid/*complications/*pathology[MESH]|Biopsy, Needle[MESH]|Bronchoalveolar Lavage[MESH]|Cohort Studies[MESH]|Female[MESH]|Humans[MESH]|Immunohistochemistry[MESH]|Lung Diseases, Interstitial/*complications/*pathology[MESH]|Male[MESH]|Middle Aged[MESH]|Probability[MESH]|Respiratory Function Tests[MESH]|Retrospective Studies[MESH]|Sensitivity and Specificity[MESH]|Severity of Illness Index[MESH]|Statistics, Nonparametric[MESH]|Tomography, X-Ray Computed[MESH] |
