Chest
Original ResearchDiffuse Lung DiseaseFeaturedFunctional Impact of a Spectrum of Interstitial Lung Abnormalities in Rheumatoid Arthritis
Section snippets
Study Design
Protocols for participant enrollment and data collection in the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS) have been described previously.9, 10 The BRASS registry is a large, single-center, prospective, observational cohort of 1,145 subjects established in 2003. Patients aged ≥ 18 years with a diagnosis of RA1 were recruited from rheumatology practices. Information was collected on > 1,000 variables including demographics, RA disease activity, and comorbidities.
Results
Of 1,145 BRASS subjects, 188 subjects (16%) had clinically indicated chest CT scans performed as part of routine care or due to a change in symptoms, such as hypoxia or increased dyspnea (Fig 1). Subjects were excluded if radiologic changes suggesting concurrent illness (ie, pleural effusions or pneumonia) limited the CT scan interpretation (n = 47) (e-Table 1). The remaining 141 subjects were scored for ILAs, as discussed later in this section. Ten individuals (29%) with subclinical ILD and
Discussion
Our study demonstrates that patients with RA who also have ILAs or radiologically severe ILAs have a spectrum of disease severity that is associated with smoking, severity of RA, and physiologic and functional decrements of varying degrees. Individuals with ILAs had increased cough and dyspnea, and decreased PFT results and 6-min walk distance (6MWD). Individuals with radiologically severe ILAs had similar but more severe increases in respiratory symptoms, as well as functional decrements of a
Conclusions
In our study, subjects with ILAs and RA-ILD were older, reported an increased smoking history, had increased RA disease severity, and had a spectrum of functional and physiologic decrements. Additional prospective and longitudinal follow-up studies will be important to verify these abnormalities, to evaluate if the decrements present in subclinical disease are progressive, and to determine the best way to screen for RA-ILD in an outpatient clinical setting.
Acknowledgments
Author contributions: T. J. D., M. L. F., C. K. I., and I. O. R. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. T. J. D. served as principal author. T. J. D., P. F. D., and K. B. contributed to data acquisition; T. J. D. contributed to data analysis and interpretation; H. H., M. N., M. E. W., D. P. A., G. R. W., G. M. H., A. M. K. C., N. A. S., and I. O. R. contributed to the statistical analysis and
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FUNDING/SUPPORT: Dr Doyle is supported by the KL2/Catalyst MeRIT Program [Grant 8KL2TR000168-05]. Drs Nishino, Hunninghake, and Rosas are supported by the US National Institutes of Health (NIH) [Grant K23 CA157631 (National Cancer Institute) to Dr Nishino, Grants K08 HL092222 and R01 HL111024 to Dr Hunninghake, and Grant K23 HL087030 to Dr Rosas]. The Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study is currently sponsored by Crescendo Bioscience Inc, MedImmune LLC, and Bristol-Myers Squibb Co.
Parts of this article have been presented or published in abstract form (17th International Colloquium on Lung & Airway Fibrosis, October 1, 2012, Modena, Italy, and Doyle TJ, Batra K, Frits ML, et al. Am J Resp Crit Care Med. 2013;187[1_MeetingAbstracts]:A22).
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