RESEARCH - Asymptomatic interstitial lung disease common in patients with RA

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Asymptomatic interstitial lung disease common in patients with RA

By Reuters Health

February 6, 2008

NEW YORK (Reuters Health), Feb 6 - Preclinical interstitial lung

disease detected by high-resolution computed tomography is prevalent

and progressive in patients with rheumatoid arthritis, according to

research in the Archives of Internal Medicine for January 28.

The prevalence of asymptomatic interstitial lung disease (ILD) in

rheumatoid arthritis (RA) is unknown, lead author Dr. Bernadette R.

Gochuico and colleagues note. Nonetheless, given the availability of

new therapeutic options, early identification and treatment may

improve outcomes.

The authors recruited 64 patients with RA without dyspnea or cough and

10 with RA and pulmonary fibrosis.

High-resolution computed tomography identified preclinical ILD in 21

of the asymptomatic patients (33%).

Air flow and lung volumes were normal in the ILD patients at baseline,

but gas exchange was impaired, as evidenced by lower percentage of

predicted diffusion capacity of carbon monoxide and higher

alveolar-arterial oxygen gradient compared with subjects with no ILD.

During a mean follow-up of 2 years, repeat scanning showed disease

progression in 12 subjects with preclinical ILD and in 6 subjects with

pulmonary fibrosis; the rate of change was low and similar in the two

groups.

" In this cohort of patients with RA, preclinical ILD is prevalent and

progressive, " Dr. Gochuico's team writes. " The natural history of

disease resembles that of pulmonary fibrosis, and high resolution

computed tomography is more sensitive than pulmonary function test

measurements in detecting early progression of preclinical ILD. "

Two thirds of patients with lung disease and less than one quarter

without lung disease had a history of smoking, and the mean number of

pack-years smoked was significantly higher in the lung disease group.

Therefore, the authors say, clinicians should recommend smoking

cessation for patients with RA.

They conclude: " High resolution computed tomography may be indicated

to identify early preclinical ILD in patients with RA whose physical

examinations reveal crackles. "

Last Updated: 2008-02-05 13:09:45 -0400 (Reuters Health)

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