RT Journal Article
SR Electronic
T1 Usual interstitial pneumonia preceding rheumatoid arthritis: Clinical, imaging, and histopathologic features
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA4887
DO 10.1183/13993003.congress-2016.PA4887
VO 48
IS suppl 60
A1 Yutaka Tsuchiya
A1 David Lynch
A1 Takeshi Johkoh
A1 Thomas Colby
A1 Junya Fukuoka
A1 Ryoko Egashira
A1 Hiromitsu Sumikawa
A1 Takenori Okada
A1 Jeffrey Swigris
A1 Joshua Solomon
YR 2016
UL http://erj.ersjournals.com/content/48/suppl_60/PA4887.abstract
AB Purpose: To determine which clinical, radiologic, or histopathologic characteristics might predict which patients with idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP) go on to develop rheumatoid arthritis (UIP/pre-RA).Methods: We reviewed the records of 74 patients (IPF/UIP, 63; UIP/pre-RA, 11) with UIP-pattern identified in surgical lung biopsy specimens. For the study, chest CT and histopathology slides were re-reviewed by two expert pulmonary radiologists and pathologists respectively.Results: The median follow up period was 4.2 years. In patients with UIP/pre-RA, mean duration from UIP diagnosis to RA development was 0.9 years. There were no significant differences in clinical features or CT findings between two groups. UIP/pre-RA group was more likely to have higher pO2 (p=0.009), rheumatoid factor, anti-cyclic citrullinated peptide antibody (p<0.0001, respectively), lymphocyte in bronchoalveolar lavage fluid (p=0.03) at baseline. Histologically, UIP/pre-RA group had higher germinal centers score (p<0.0001) with lower fibroblastic foci score (p=0.0025) than IPF/UIP group. In multivariate analysis, the best descriminitives between the two groups were the fibrobrastic foci score and the germinal centers score (odds ratio, 0.009; 9.40, p < 0.001).Conclusions: Clinical and radiologic features of UIP/pre-RA were similar to those seen in IPF/UIP. The fibrobrastic foci score and germinal centers score were the best discriminative between IPF/UIP and UIP/pre-RA patients. In patients with IPF/UIP and a low fibrobrastic foci score and high germinal center score on biopsy, there is a risk of development of RA in the future.