TY - JOUR
T1 - Functional impact of a spectrum of interstitial lung abnormalities in rheumatoid arthritis
AU - Doyle, Tracy J.
AU - Dellaripa, Paul F.
AU - Batra, Kerri
AU - Frits, Michelle L.
AU - Iannaccone, Christine K.
AU - Hatabu, Hiroto
AU - Nishino, Mizuki
AU - Weinblatt, Michael E.
AU - Ascherman, Dana P.
AU - Washko, George R.
AU - Hunninghake, Gary M.
AU - Choi, Augustine M.K.
AU - Shadick, Nancy A.
AU - Rosas, Ivan O.
N1 - Funding Information:
FUNDING/SUPPORT: Dr Doyle is supported by the KL2/Catalyst MeRIT Program [Grant 8KL2TR000168-05]. Drs Nishino, Hunninghake, and Rosas are supported by the US National Institutes of Health (NIH) [Grant K23 CA157631 (National Cancer Institute) to Dr Nishino, Grants K08 HL092222 and R01 HL111024 to Dr Hunninghake, and Grant K23 HL087030 to Dr Rosas]. The Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study is currently sponsored by Crescendo Bioscience Inc, MedImmune LLC, and Bristol-Myers Squibb Co.
Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Weinblatt has received consulting fees and grant support from Bristol-Myers Squibb Co, MedImmune LLC, and Crescendo Bioscience Inc, and has received consulting fees from Stromedix/Biogen, Synovex Corp, and Sanofi SA. Dr Shadick receives research grant funding from Crescendo Biosciences Inc, MedImmune LLC, Bristol-Myers Squibb Co, Amgen Inc, Genentech Inc, and Abbott Laboratories, and has received consulting fees from Stromedix/Biogen, Synovex Corp, and Sanofi SA. Dr Rosas has received consulting fees from Stromedix/Biogen, Synovex Corp, and Sanofi SA. The remaining authors have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2014/7
Y1 - 2014/7
N2 - BACKGROUND: Approximately 10% of patients with rheumatoid arthritis (RA) have interstitial lung disease (ILD), and one-third have subclinical ILD on chest CT scan. In this study, we aimed to further characterize functional decrements in a spectrum of RA-associated ILD. M ETHODS: All subjects were enrolled in the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS).The presence of interstitial lung abnormalities (ILAs) on clinically indicated chest CT scans was determined using a previously validated sequential reading method. Univariate and multivariate analyses were used to assess the association between degree of ILAs and physiologic, functional, and demographic variables of interest. R ESULTS: Of 1,145 BRASS subjects, 91 subjects (8%) were included in this study. Twelve had radiologically severe ILAs, 34 had ILAs, and 38 had no ILAs on CT scan. Subjects with radiologically severe ILAs were older ( P = .0037), had increased respiratory symptoms (cough, P = .027; dyspnea, P = .010), and more severe RA disease (rheumatoid factor, P = .018; total swollen joints, P = .046) compared with subjects with no ILAs. Participants also had a trend toward having an increased smoking history ( P = .16) and having lower FVC % predicted (77% vs 94%, P = .097) and diff usion capacity of carbon monoxide % predicted (52% vs 77%, P = .068). Similar but attenuated increases in respiratory symptoms, functional decrements, and RA disease severity were observed in subjects with ILAs compared with those with no ILAs. C ONCLUSIONS: We have shown that patients with RA have varying degrees of ILAs that are associated with a spectrum of functional and physiologic decrements. Our findings suggest that improved risk stratification and detection of ILAs will provide a therapeutic window that could improve RA-ILD outcomes.
AB - BACKGROUND: Approximately 10% of patients with rheumatoid arthritis (RA) have interstitial lung disease (ILD), and one-third have subclinical ILD on chest CT scan. In this study, we aimed to further characterize functional decrements in a spectrum of RA-associated ILD. M ETHODS: All subjects were enrolled in the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS).The presence of interstitial lung abnormalities (ILAs) on clinically indicated chest CT scans was determined using a previously validated sequential reading method. Univariate and multivariate analyses were used to assess the association between degree of ILAs and physiologic, functional, and demographic variables of interest. R ESULTS: Of 1,145 BRASS subjects, 91 subjects (8%) were included in this study. Twelve had radiologically severe ILAs, 34 had ILAs, and 38 had no ILAs on CT scan. Subjects with radiologically severe ILAs were older ( P = .0037), had increased respiratory symptoms (cough, P = .027; dyspnea, P = .010), and more severe RA disease (rheumatoid factor, P = .018; total swollen joints, P = .046) compared with subjects with no ILAs. Participants also had a trend toward having an increased smoking history ( P = .16) and having lower FVC % predicted (77% vs 94%, P = .097) and diff usion capacity of carbon monoxide % predicted (52% vs 77%, P = .068). Similar but attenuated increases in respiratory symptoms, functional decrements, and RA disease severity were observed in subjects with ILAs compared with those with no ILAs. C ONCLUSIONS: We have shown that patients with RA have varying degrees of ILAs that are associated with a spectrum of functional and physiologic decrements. Our findings suggest that improved risk stratification and detection of ILAs will provide a therapeutic window that could improve RA-ILD outcomes.
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U2 - 10.1378/chest.13-1394
DO - 10.1378/chest.13-1394
M3 - Article
C2 - 24305643
AN - SCOPUS:84903836802
VL - 146
SP - 41
EP - 50
JO - CHEST
JF - CHEST
SN - 0012-3692
IS - 1
ER -