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Usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease

E. J. Kim, B. M. Elicker, F. Maldonado, W. R. Webb, J. H. Ryu, J. H. Van Uden, J. S. Lee, T. E. King Jr, H. R. Collard
European Respiratory Journal 2010 35: 1322-1328; DOI: 10.1183/09031936.00092309
E. J. Kim
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B. M. Elicker
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F. Maldonado
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W. R. Webb
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J. H. Ryu
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J. H. Van Uden
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J. S. Lee
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T. E. King Jr
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H. R. Collard
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  • Fig. 1—
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    Fig. 1—

    Flow chart showing the high-resolution computed tomography (HRCT) pattern in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Of 99 patients with RA-ILD, 84 had HRCT scans available within 1 yr of initial presentation and enrolment into a longitudinal cohort. The HRCT pattern distribution is shown. The two cases with an alternative pattern (organising pneumonia (n = 1) and bronchiolitis (n = 1)) were excluded from the study analysis. NSIP: nonspecific interstitial pneumonia; UIP: usual interstitial pneumonia.

  • Fig. 2—
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    Fig. 2—

    Kaplan–Meier survival curve for patients with a rheumatoid arthritis (RA)-associated usual interstitial pneumonia (UIP) pattern (RA-UIP; ––––), a RA-associated non-UIP pattern (RA-non-UIP; ······) and idiopathic pulmonary fibrosis (IPF; ------). Comparing across all three groups, there were significant differences in survival estimates (p = 0.01). The estimated median survival in RA-UIP was significantly worse than that in RA-non-UIP (3.2 versus 6.6 yrs; p = 0.04). Estimated median survival in RA-UIP did not differ significantly from that in IPF (3.2 versus 2.6 yrs; p = 0.66).

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    Fig. 3—

    Kaplan–Meier survival curve for patients with rheumatoid arthritis-associated interstitial lung disease based on high-resolution computed tomography (HRCT) pattern. Comparing the three main HRCT patterns (–––––: definite usual interstitial pneumonia (UIP); -------: likely nonspecific interstitial pneumonia (NSIP); ······: indeterminate UIP/NSIP), there was a trend toward differences in survival estimates (p = 0.06). The estimated median survival in definite UIP was significantly worse than that in likely NSIP (3.2 yrs versus incalculable; p = 0.02). The estimated median survival for an indeterminate UIP/NSIP pattern did not differ from that for definite UIP and likely NSIP (6.6 versus 3.2 yrs (p = 0.15) and 6.6 yrs versus incalculable (p = 0.19), respectively).

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    Fig. 4—

    Flow chart of histopathology and high-resolution computed tomography (HRCT) pattern in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Histopathology was available for 18 of the RA-ILD patients. UIP: usual interstitial pneumonia; NSIP: nonspecific interstitial pneumonia; TBB: transbronchial biopsy; SLB: surgical lung biopsy; OP: organising pneumonia; DAD: diffuse alveolar damage.

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    Fig. 5—

    Medication use in rheumatoid arthritis-associated interstitial lung disease patients. Medication regimens from the time of the initial and last follow-up visit were reviewed. Prednisone was the most common agent prescribed, followed by methotrexate (MTX) and an anti-tumour necrosis factor (anti-TNF) agent.

Tables

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  • Table 1—

    Demographic and clinical characteristics of rheumatoid arthritis-associated interstitial lung disease patients

    Populationp-value
    RA-UIPRA-non-UIPIPFOverallRA-non-UIP#IPF#
    Subjects n206251
    Age yrs69±665±1072±90.0010.150.08
    Male sex5550750.030.700.11
    Duration of RA yrs7 (3–30)2 (0–9)NANA0.03NA
    Ever-smoker5577760.120.050.07
    FVC % pred66±2570±2069±210.720.390.63
    DL,CO % pred50±2248±2141±160.100.560.07
    • Data are presented as mean±sd, percentage or median (interquartile range), unless otherwise indicated. RA-UIP: usual interstitial pneumonia (UIP) pattern in patients with rheumatoid arthritis (RA); RA-non-UIP: non-UIP pattern in patients with RA; IPF: idiopathic pulmonary fibrosis; FVC: forced vital capacity; DL,CO: diffusing capacity of the lung for carbon monoxide; NA: not applicable; % pred: percentage of the predicted value. #: versus RA-UIP.

  • Table 2—

    Predictors of survival time in patients with rheumatoid arthritis-associated interstitial lung disease

    BivariateMultivariate
    Hazard ratiop-valueHazard ratiop-value
    Female sex0.550.100.300.008
    Baseline FVC (% pred)0.980.01
    Baseline DL,CO (% pred)0.970.0020.960.003
    Definite UIP pattern#2.090.042.340.05
    • Hazard ratios reflect the relative risk of death associated with the given variable (or, for continuous variables, a one-unit increase in the variable). FVC: forced vital capacity; DL,CO: diffusing capacity of the lung for carbon monoxide; UIP: usual interstitial pneumonia; % pred: percentage of the predicted value. #: on high-resolution computed tomography.

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Usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease
E. J. Kim, B. M. Elicker, F. Maldonado, W. R. Webb, J. H. Ryu, J. H. Van Uden, J. S. Lee, T. E. King, H. R. Collard
European Respiratory Journal Jun 2010, 35 (6) 1322-1328; DOI: 10.1183/09031936.00092309

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Usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease
E. J. Kim, B. M. Elicker, F. Maldonado, W. R. Webb, J. H. Ryu, J. H. Van Uden, J. S. Lee, T. E. King, H. R. Collard
European Respiratory Journal Jun 2010, 35 (6) 1322-1328; DOI: 10.1183/09031936.00092309
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