PT  - JOURNAL ARTICLE
AU  - Tsuchiya, Yutaka
AU  - Lynch, David
AU  - Johkoh, Takeshi
AU  - Colby, Thomas
AU  - Fukuoka, Junya
AU  - Egashira, Ryoko
AU  - Sumikawa, Hiromitsu
AU  - Okada, Takenori
AU  - Swigris, Jeffrey
AU  - Solomon, Joshua
TI  - Usual interstitial pneumonia preceding rheumatoid arthritis: Clinical, imaging, and histopathologic features
AID  - 10.1183/13993003.congress-2016.PA4887
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - PA4887
VI  - 48
IP  - suppl 60
4099  - http://erj.ersjournals.com/content/48/suppl_60/PA4887.short
4100  - http://erj.ersjournals.com/content/48/suppl_60/PA4887.full
SO  - Eur Respir J2016 Sep 01; 48
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.