Histopathologic pattern and clinical features of rheumatoid arthritis-associated interstitial lung disease.
OBJECTIVE
To investigate the histopathologic pattern and clinical features of patients with rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) according to the American Thoracic Society (ATS)/European Respiratory Society consensus classification of idiopathic interstitial pneumonia.


METHODS
Retrospective review.


METHODS
Two thousand-bed, university-affiliated, tertiary referral center.


METHODS
Eighteen patients with RA who underwent surgical lung biopsy (SLBx) for suspected ILD.


METHODS
SLBx specimens were reviewed and reclassified by three lung pathologists according to the ATS/European Respiratory Society classification. Clinical features and follow-up courses for the usual interstitial pneumonia (UIP) pattern and the nonspecific interstitial pneumonia (NSIP) pattern were compared.


RESULTS
The histopathologic patterns were diverse: 10 patients with the UIP pattern, 6 patients with the NSIP pattern, and 2 patients with inflammatory airway disease with the organizing pneumonia pattern. RA preceded ILD in the majority of patients (n = 12). In three patients, ILD preceded RA; in three patients, both conditions were diagnosed simultaneously. The majority (n = 13) of patients had a restrictive defect with or without low diffusion capacity of the lung for carbon monoxide (D(LCO)) on pulmonary function testing; 2 patients had only low (D(LCO)). The UIP and NSIP groups were significantly different in their male/female ratios (8/2 vs 0/6, respectively; p = 0.007) and smoking history (current/former or nonsmokers, 8/2 vs 0/6; p = 0.007). Many of the patients with the UIP pattern had typical high-resolution CT features of UIP. Five patients with the UIP pattern died, whereas no deaths occurred among patients with the NSIP pattern during median follow-up durations of 4.2 years and 3.7 years, respectively.


CONCLUSIONS
The histopathologic type of RA-ILD was diverse; in our study population, the UIP pattern seemed to be more prevalent than the NSIP pattern.
Lee
Hyun-Kyung
HK
Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, 388-1, Poongnap-dong, Songpa-ku, Seoul, Korea 138-73.
Kim
Dong Soon
DS
Yoo
Bin
B
Seo
Joon Beom
JB
Rho
Jae-Yoon
JY
Colby
Thomas V
TV
Kitaichi
Masanori
M
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000473:pathology*; D001707:Biopsy, Needle; D018893:Bronchoalveolar Lavage; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017563:Lung Diseases, Interstitial / Q000150:complications* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011336:Probability; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed