Background Lungs are one of the target organs in rheumatoid arthritis (RA) patients. Interstitial lung disease (ILD), rheumatoid nodules, pleural effusion, bronchiectasia and small airway disease are common manifestations of lung involvement.
Objectives Objective of this study was to evaluate distribution of Thorax CT findings and treatment features in RA patients registered in a biologic registry.
Methods HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a prospective, single center database of biological treatments including 1229 RA patients by August 2016. Demographics, clinical and serological features of patients and thorax CT results performed in Hacettepe University between 2000 and 2016 were retrospectively evaluated. Patients whose CT was reported as small airway disease or ILD by radiologists, were evaluated as a subgroup. Data included type of biological treatments before diagnose of ILD and at last control as well.
Results Among 1229 patients (78.8% female), mean age was 53.3±12.9 and disease duration was 11.4±7.9. Thorax CT had been performed in 203 (16.5%) patients. Distribution of pathologic findings in thorax CT was represented in Table 1. 29 patients (%2.4) were diagnosed as ILD with regard to CT findings. Patients with ILD were older (64.5±6.7 vs 60.6±10.1, p=0.039) and more frequently positive for rheumatoid factor (RF) (25/27 (%92.6) vs 77/121 (%63.3), p=0.003) than patients without ILD. ILD was detected before beginning of biologics in 11 (37.9%) patients and during biologic treatment in 18 (62.1%) patients. Honeycombing was seen in 10 (34.5%) patients. First choice of biologic agent was RTX in 10 (34.5%) and TNFi in 19 (65.5%) patients. In ILD patients, mean follow-up duration was 51±31 months and first biologic was switched to another in 16 (55.2%) of patients. At the last follow-up visit 19 (65.5%) patients were on rituximab, 3 (10.3%) patients were on abatacept and 7 (24.1%) were on TNFi. Small airway disease was detected in 19 (9.3%) patients. History of smoking was present in only 4 (21.0%) of patients with small airway disease.
Conclusions Bronciectasia, rheumatoid nodules, small airway disease and ILD were the most frequent CT findings of RA patients. Rituximab was the choice of first biologic treatment in one third of patients, however two-thirds of patients were on rituximab therapy at the last follow-up visit. Lung involvement stands out as an important factor in selection of biologics.
Disclosure of Interest None declared