Predictors of progression of HRCT diagnosed fibrosing alveolitis in patients with rheumatoid arthritis

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Ann Rheum Dis 2002 Jun;61(6):517-521

Predictors of progression of HRCT diagnosed fibrosing alveolitis in

patients with rheumatoid arthritis.

Dawson JK, Fewins HE, Desmond J, Lynch MP, Graham DR.

Department of Rheumatology, St Helens and Knowsley Trust Hospitals,

Liverpool, UK Department of Radiology, Cardiothoracic Centre, Liverpool,

UK Department of Radiology, St Helens and Knowsley Trust Hospitals

Department of Respiratory Medicine, St Helens and Knowsley Trust

Hospitals.

Background: Fibrosing alveolitis (FA) is the most serious

pleuropulmonary extra-articular feature of rheumatoid arthritis (RA).

Features that predict progression of FA in patients with RA have not yet

been determined. Objective: To identify clinical features that predict

progressive FA in patients with RA. Methods: An unselected cohort of 29

patients with RA and FA confirmed by high resolution computed tomography

(HRCT) were studied prospectively for 24 months. Three monthly clinical

assessment, four monthly pulmonary function tests, and yearly HRCT

scanning was undertaken on these patients. Progressive FA was defined as

>15% fall in carbon monoxide transfer factor (TLCO) with evidence of

increasing FA on HRCT or death as a result of FA. Results: During 24

months of follow up 10/29 (34%) patients had progressive FA. Progression

on HRCT was seen as acute ground glass exacerbations or increasing

reticular pattern lung involvement. Progressive FA was associated with

the presence of bibasal crackles (p=0.041), TLCO (p=0.001), and extent

(p=0.026) and distribution (p=0.031) of lung involvement on HRCT at

initial presentation. When multiple logistic regression was used, only

TLCO remained significant. Receiver operator curve analysis was employed

to identify presenting TLCO of progressive FA. A TLCO <54% of the

predicted value demonstrated 80% sensitivity and 93% specificity in

predicting progressive FA. Conclusions: A TLCO <54% of the predicted

value is a highly specific predictor of disease progression.

PMID: 12006324