类风湿关节炎中一系列肺间质异常和疾病的基线特征和进展。
Baseline Characteristics and Progression of a Spectrum of Interstitial Lung Abnormalities and Disease in Rheumatoid Arthritis.
机构信息
Pulmonary Division, Hospital das Clinicas HCFMUSP, Medical School, University of Sao Paulo, São Paulo, Brazil; Research Institute, Hospital do Coração (HCor), São Paulo, Brazil.
Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
出版信息
Chest. 2020 Oct;158(4):1546-1554. doi: 10.1016/j.chest.2020.04.061. Epub 2020 May 16.
BACKGROUND
Interstitial lung abnormalities (ILA) and interstitial lung disease (ILD) are seen in up to 60% of individuals with rheumatoid arthritis (RA), some of which will progress to have a significant impact on morbidity and mortality rates. Better characterization of progressive interstitial changes and identification of risk factors that are associated with progression may enable earlier intervention and improved outcomes.
RESEARCH QUESTION
What are baseline characteristics associated with RA-ILD progression?
STUDY DESIGN AND METHODS
We performed a retrospective study in which all clinically indicated CT chest scans in adult individuals with RA from 2014 to 2016 were evaluated for interstitial changes, and the data were further subdivided into ILA and ILD based on clinical record review. Progression was determined visually and subsequently semiquantified.
RESULTS
Those individuals with a spectrum of interstitial changes (64 of 293) were older male smokers and less likely to be receiving biologics/small molecule disease-modifying antirheumatic drugs. Of 44% of the individuals with ILA, 46% had had chest CT scans performed for nonpulmonary indications. Of the 56 individuals with ILA/ILD with sequential CT scans, 38% had evidence of radiologic progression over 4.4 years; 29% of of individuals with ILA progressed. Risk factors for progressive ILA/ILD included a subpleural distribution and higher baseline involvement.
INTERPRETATION
Of 293 individuals with RA with clinically indicated CT scans, interstitial changes were observed in 22%, one-half of whom had had a respiratory complaint at the time of imaging; radiologic progression was seen in 38%. Of individuals with progressive ILA, one-half had had baseline CT scans performed for nonpulmonary indications. Subpleural distribution and higher baseline ILA/ILD extent were risk factors associated with progression. Prospective longitudinal studies of RA-ILA are necessary.
背景
间质性肺异常（ILA）和间质性肺疾病（ILD）在高达 60%的类风湿关节炎（RA）患者中可见，其中一些会进展为对发病率和死亡率有重大影响。更好地描述进行性间质变化，并确定与进展相关的危险因素，可能会实现更早的干预和改善结果。
研究问题
与 RA-ILD 进展相关的基线特征是什么？
研究设计和方法
我们进行了一项回顾性研究，对 2014 年至 2016 年间所有临床指征的 CT 胸部扫描进行了评估，以确定成人 RA 患者的间质变化，并根据临床记录进一步将数据细分为 ILA 和 ILD。通过视觉确定进展，随后进行半定量评估。
结果
293 例具有各种间质变化的患者中（64 例）为年龄较大的男性吸烟者，且更不可能接受生物制剂/小分子疾病修正抗风湿药物治疗。44%的 ILA 患者中，有 46%的患者因非肺部原因进行了胸部 CT 检查。56 例 ILA/ILD 患者中有连续 CT 扫描的患者中，38%在 4.4 年内有影像学进展证据；29%的 ILA 患者进展。进行性 ILA/ILD 的危险因素包括胸膜下分布和基线较高的受累程度。
解释
在 293 例有临床指征进行 CT 扫描的 RA 患者中，有 22%观察到间质变化，其中一半在进行影像学检查时有呼吸系统症状；有 38%的患者出现了影像学进展。在进展性 ILA 的患者中，有一半的患者在基线 CT 扫描时进行了非肺部检查。胸膜下分布和基线 ILA/ILD 程度较高是与进展相关的危险因素。有必要对 RA-ILA 进行前瞻性纵向研究。
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