Temiz Karadag Duygu, Dogan Sevtap, Cakir Ozgur, Altıntas Yusuf, Yilmaz Seyma, Gökcen Neslihan, Yazici Ayten, Cefle Ayse
Division of Rheumatology, Department of Internal Medicine, Kocaeli University Faculty of Medicine, İzmit, Kocaeli, 41380, Turkey.
Department of Radiology, Kocaeli University Faculty of Medicine, İzmit, Kocaeli, Turkey.
Clin Rheumatol. 2025 Jun;44(6):2213-2223. doi: 10.1007/s10067-025-07443-7. Epub 2025 May 15.
Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) presents with variable severity and progression, highlighting the need for effective tools to identify patients at risk. Although CT imaging plays a vital role in the management of RA-ILD, there is a lack of objective methods to predict disease progression. This study investigates the association between semi-quantitative and quantitative CT scoring methods and disease progression in early-stage RA-ILD.
This observational study analyzed baseline and the first technically evaluable follow-up CT scans of patients who met the 2010 ACR/EULAR classification criteria for RA and were diagnosed with ILD. Only patients with ≤ 5 years between baseline and follow-up scans were included. Semi-quantitative assessments were conducted using the Goh and Warrick scoring systems, while quantitative analyses utilized Vitrea software to measure mean lung attenuation (MLA) and low-, medium-, and high-density lung volumes. Progression risk factors were evaluated using binary logistic regression, with progression defined by changes in CT parameters over time.
A total of 77 RA-ILD patients (45 females, 32 males) were included, with a median follow-up period of 20 months (interquartile range: 7.4-46 months). Disease progression was observed in 34 patients (44.2%). Baseline medium-density volume (MDV), follow-up mean lung attenuation (MLA), and low-density volume (LDV) differed significantly between the progression and non-progression groups (p < 0.05). Quantitative CT parameters demonstrated strong correlations with both the Goh and Warrick scoring systems. Binary logistic regression analysis identified the usual interstitial pneumonia (UIP) pattern on baseline imaging as the only independent predictor of disease progression (odds ratio: 3.1; 95% confidence interval: 1.1-12.4).
In this study of early-stage RA-ILD patients, only the usual interstitial pneumonia (UIP) pattern on baseline HRCT independently predicted disease progression. Neither semi-quantitative scores nor quantitative CT parameters were predictive of progression. However, quantitative CT metrics demonstrated strong correlations with traditional scoring systems, supporting their utility in objectively assessing disease extent.
类风湿关节炎相关间质性肺疾病（RA-ILD）的严重程度和进展情况各不相同，这凸显了需要有效的工具来识别有风险的患者。尽管CT成像在RA-ILD的管理中起着至关重要的作用，但缺乏预测疾病进展的客观方法。本研究调查了半定量和定量CT评分方法与早期RA-ILD疾病进展之间的关联。
这项观察性研究分析了符合2010年美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）类风湿关节炎分类标准且被诊断为ILD的患者的基线CT扫描和首次可进行技术评估的随访CT扫描。仅纳入基线扫描和随访扫描间隔≤5年的患者。使用Goh和Warrick评分系统进行半定量评估，而定量分析则利用Vitrea软件测量平均肺衰减（MLA）以及低、中、高密度肺容积。使用二元逻辑回归评估进展风险因素，进展定义为CT参数随时间的变化。
共纳入77例RA-ILD患者（45例女性，32例男性），中位随访期为20个月（四分位间距：7.4 - 46个月）。34例患者（44.2%）出现疾病进展。进展组和非进展组之间的基线中密度容积（MDV）、随访平均肺衰减（MLA）和低密度容积（LDV）存在显著差异（p < 0.05）。定量CT参数与Goh和Warrick评分系统均显示出强相关性。二元逻辑回归分析确定基线成像上的普通型间质性肺炎（UIP）模式是疾病进展的唯一独立预测因素（比值比：3.1；95%置信区间：1.1 - 12.4）。
在这项针对早期RA-ILD患者的研究中，仅基线高分辨率CT（HRCT）上的普通型间质性肺炎（UIP）模式可独立预测疾病进展。半定量评分和定量CT参数均不能预测疾病进展。然而，定量CT指标与传统评分系统显示出强相关性，支持其在客观评估疾病范围方面的实用性。
