Rheumatoid arthritis-related lung disease detected on clinical chest computed tomography imaging: Prevalence, risk factors, and impact on mortality

doi:10.1016/j.semarthrit.2020.08.015

. 2020 Dec;50(6):1216-1225.

doi: 10.1016/j.semarthrit.2020.08.015. Epub 2020 Sep 28.

Rheumatoid arthritis-related lung disease detected on clinical chest computed tomography imaging: Prevalence, risk factors, and impact on mortality

Affiliations

¹ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
² Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States.
³ Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States; Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States.
⁴ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, United States.
⁵ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, United States; Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, United States.
⁶ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States. Electronic address: Jsparks@bwh.harvard.edu.

PMID: 33059295
PMCID: PMC7736489
DOI: 10.1016/j.semarthrit.2020.08.015

Rheumatoid arthritis-related lung disease detected on clinical chest computed tomography imaging: Prevalence, risk factors, and impact on mortality

Sicong Huang et al. Semin Arthritis Rheum. 2020 Dec.

. 2020 Dec;50(6):1216-1225.

doi: 10.1016/j.semarthrit.2020.08.015. Epub 2020 Sep 28.

Authors

Affiliations

¹ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
² Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States.
³ Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States; Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States.
⁴ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, United States.
⁵ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, United States; Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, United States.
⁶ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States. Electronic address: Jsparks@bwh.harvard.edu.

PMID: 33059295
PMCID: PMC7736489
DOI: 10.1016/j.semarthrit.2020.08.015

Abstract

Objective: We aimed to determine the real-world prevalence and investigate risk factors for rheumatoid arthritis (RA)-related lung disease on chest computed tomography (CT) imaging. We also investigated the impact of RA-related lung disease on mortality.

Methods: We studied chest CT imaging abnormalities among RA patients. We determined the presence and type of abnormalities using the chest CT imaging radiologic report. RA-related lung disease was defined as interstitial lung disease (ILD), bronchiectasis, or pleural disease. We examined whether demographics and RA characteristics were associated with RA-related lung disease using logistic regression. RA-related lung disease and mortality was described using survival curves and Cox regression.

Results: We analyzed 190 patients who had chest CT imaging performed for clinical indications. Mean age was 64.2 years (SD 11.8), 80.0% were female, and 75.3% were seropositive. RA-related lung disease was detected in 54 patients (28.4%); 30 (15.8%) had ILD, 27 (14.2%) had bronchiectasis, and 18 (9.5%) had pleural disease. RA-related lung disease was reported in both seropositive and seronegative RA (28.7% vs. 27.7%, p = 1.00). Male sex (OR 2.62, 95%CI 1.17-5.88) and current methotrexate use (OR 2.73, 95%CI 1.27-5.61 vs. not current) were associated with RA-related lung disease. Twenty-four (44.4%) patients with RA-related lung disease died during mean 7.0 years of follow-up. RA-related lung disease had HR of 5.35 (95%CI 0.72-39.9) for mortality compared to normal chest CT.

Conclusions: In this real-world study, RA-related lung disease was commonly detected on chest CT imaging regardless of RA serostatus. RA-related lung disease had high mortality, emphasizing the importance in close monitoring of these patients.

Keywords: CCP; Pulmonary disease; RF; Rheumatoid arthritis; Serostatus.

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Figures

**Figure 1.**
Kaplan-Meier curves for mortality based on number of abnormal impressions (0/normal, 1, 2+) noted on clinical chest computed tomography imaging report.

**Figure 2.**
Kaplan-Meier curves for mortality based on impressions noted on clinical chest computed tomography imaging report. a) Normal, RA-related lung disease (bronchiectasis, ILD, pleural disease), emphysema/hyperinflation, and pulmonary nodules; b) Normal and other non-RA-related manifestations (malignancy, pulmonary embolism, infection, lymphadenopathy, atelectasis, and other). Each patient was classified according to the most severe clinical impression to avoid double-counting.

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References

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[1] Sparks JA, Rheumatoid Arthritis. Ann Intern Med, 2019. 170(1): p. ITC1–ITC16. - PubMed

[2] Sparks JA, Rheumatoid Arthritis. Ann Intern Med, 2019. 170(1): p. ITC1–ITC16. - PubMed

[3] Turesson C, et al., Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis, 2003. 62(8): p. 722–7. - PMC - PubMed

[4] Turesson C, et al., Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis, 2003. 62(8): p. 722–7. - PMC - PubMed

[5] Chansakul T, et al., Intra-thoracic rheumatoid arthritis: Imaging spectrum of typical findings and treatment related complications. Eur J Radiol, 2015. 84(10): p. 1981–91. - PMC - PubMed

[6] Chansakul T, et al., Intra-thoracic rheumatoid arthritis: Imaging spectrum of typical findings and treatment related complications. Eur J Radiol, 2015. 84(10): p. 1981–91. - PMC - PubMed

[7] Hyldgaard C, et al., A population-based cohort study of rheumatoid arthritis-associated interstitial lung disease: comorbidity and mortality. Ann Rheum Dis, 2017. 76(10): p. 1700–1706. - PubMed

[8] Hyldgaard C, et al., A population-based cohort study of rheumatoid arthritis-associated interstitial lung disease: comorbidity and mortality. Ann Rheum Dis, 2017. 76(10): p. 1700–1706. - PubMed

[9] Gabbay E, et al., Interstitial lung disease in recent onset rheumatoid arthritis. Am J Respir Crit Care Med, 1997. 156(2 Pt 1): p. 528–35. - PubMed

[10] Gabbay E, et al., Interstitial lung disease in recent onset rheumatoid arthritis. Am J Respir Crit Care Med, 1997. 156(2 Pt 1): p. 528–35. - PubMed

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Rheumatoid arthritis-related lung disease detected on clinical chest computed tomography imaging: Prevalence, risk factors, and impact on mortality

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Rheumatoid arthritis-related lung disease detected on clinical chest computed tomography imaging: Prevalence, risk factors, and impact on mortality

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