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Usual interstitial pneumonia preceding rheumatoid arthritis: Clinical, imaging, and histopathologic features

Yutaka Tsuchiya, David Lynch, Takeshi Johkoh, Thomas Colby, Junya Fukuoka, Ryoko Egashira, Hiromitsu Sumikawa, Takenori Okada, Jeffrey Swigris, Joshua Solomon
European Respiratory Journal 2016 48: PA4887; DOI: 10.1183/13993003.congress-2016.PA4887
Yutaka Tsuchiya
1Department of Allergy and Respiratory Medicine, Showa University, Koto Toyosu Hospital, Tokyo, Japan
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David Lynch
3Department of Radiology, National Jewish Health, Denver, United States
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Takeshi Johkoh
4Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Japan
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Thomas Colby
5Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, United States
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Junya Fukuoka
8Department of Pathology, Nagasaki University School of Medicine, Nagasaki, Japan
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Ryoko Egashira
6Department of Radiology, Saga University, Saga, Japan
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Hiromitsu Sumikawa
7Department of Radiology, Osaka University, Osaka, Japan
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Takenori Okada
1Department of Allergy and Respiratory Medicine, Showa University, Koto Toyosu Hospital, Tokyo, Japan
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Jeffrey Swigris
2Department of Respiratory and Critical Care Medicine, National Jewish Health, Denver, United States
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Joshua Solomon
2Department of Respiratory and Critical Care Medicine, National Jewish Health, Denver, United States
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Abstract

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.

  • Chronic disease
  • Idiopathic pulmonary fibrosis
  • Imaging
  • Copyright ©the authors 2016
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Usual interstitial pneumonia preceding rheumatoid arthritis: Clinical, imaging, and histopathologic features
Yutaka Tsuchiya, David Lynch, Takeshi Johkoh, Thomas Colby, Junya Fukuoka, Ryoko Egashira, Hiromitsu Sumikawa, Takenori Okada, Jeffrey Swigris, Joshua Solomon
European Respiratory Journal Sep 2016, 48 (suppl 60) PA4887; DOI: 10.1183/13993003.congress-2016.PA4887

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Usual interstitial pneumonia preceding rheumatoid arthritis: Clinical, imaging, and histopathologic features
Yutaka Tsuchiya, David Lynch, Takeshi Johkoh, Thomas Colby, Junya Fukuoka, Ryoko Egashira, Hiromitsu Sumikawa, Takenori Okada, Jeffrey Swigris, Joshua Solomon
European Respiratory Journal Sep 2016, 48 (suppl 60) PA4887; DOI: 10.1183/13993003.congress-2016.PA4887
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