Background Standard treatment of patients with rheumatoid arthritis (RA) complicated with pulmonary involvements has not been clarified.
Objectives To evaluate the influence of pulmonary involvement on immunological background and treatment of patients with RA.
Methods A cross-sectional study was conducted, in which medical records of 479 RA patients who visited our hospital during September the first to November 31th, 2016 were reviewed. Pulmonary involvements were diagnosed by imaging including plain chest radiography or chest computed tomography findings. Patients were divided into two groups, with or without pulmonary involvement, and compared with immunological background (serum level of rheumatoid factor (RF), anti-CCP antibody and recent treatment.
Results Among 479 patients, pulmonary involvements were diagnosed in 158 patients (female =116), mean age was 73.4 (standard deviation (SD) 9.0) year old, and mean disease duration was 143.3 (SD 125.9) months. Pulmonary involvements included interstitial pneumonia (N=52), organizing pneumonia (N=11), airway diseases (N=36), old tuberculosis (N=18), nontuberculous mycobacteria (N=13), pleurisy (N=5). Higher anti-CCP titers were found in RA with pulmonary involvement than RA only (medians 303.9±596.5 versus 163.5±256.1 U/mL, P<0.001), and the same result was found in RF (medians 322.5±437.2 versus 157.9±277.5 IU/mL, P<0.001). Methotrexate (MTX) was less frequently used (N=56, 35.4% versus N=205, 63.9%, P<0.001), but biological agents were more used (N=31, 19.6% versus N=49, 15.3%), especially abatacept (ABT) was highly used (N=15, 9.5% versus N=8, 2.5%).
Conclusions RA patients with pulmonary involvements had high immunological response and were less prescribed MTX with may injure lungs and more used ABT. Association between pulmonary involvement and high titer of ACPA, and between positivity for RF or ACPA and good response of ABT were reported. ABT may be useful treatment for RA patients with pulmonary involvement.
Gottenberg JE et al.: Arthritis Rheumatol.68 (6):1346–1352.2016.
Rocha-Munoz AD et al.: J immunol Res. Epub 2015 May 19.
Disclosure of Interest None declared
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