Most patients recently diagnosed with rheumatoid arthritis (RA) have some airway disease, including pulmonary nodules, but in most cases the disease is mild and does not require treatment modification, according to an abstract presented at ACR Convergence 2021.

Tina Mahajan, MD, from the University of Nebraska Medical Center in Omaha, presented the findings on behalf of her research colleagues.

The authors noted that patients with RA may be at risk of several different types of pulmonary disease, including interstitial lung disease (ILD). “The prevalence of lung diseases varies substantially across studies, and there remains a poor understanding of the progression of lung diseases early in the RA disease course,” the investigators wrote. 

The researchers sought to identify the prevalence and early progression of lung diseases among patients with recently diagnosed RA by conducting a prospective cohort study of patients diagnosed with RA within the previous 2 years at an academic center during the period 2017 to 2021. 

“At baseline and 1-year follow-up visits, patient-reported outcomes measures (e.g., Modified Research Council [MRC] dyspnea scale and Health Assessment Questionnaire), clinical assessments (e.g., DAS28-ESR), and complete pulmonary function tests (PFTs) were collected,” the authors wrote. “At the initial visit, a high-resolution computed tomography (HRCT) scan of the lungs was completed with thin (1.25 mm) slices with prone and supine imaging. HRCTs were scored semiquantitatively in 6 lung regions by an expert chest radiologist blinded to clinical data.”

Of the 37 patients with new RA diagnoses, 81.1% were female, white, and had been treated with methotrexate. Almost 84% were seropositive for rheumatoid factor; 86.5% were seropositive for anti-CCP. Although 59.5% had a history of cigarette smoking, a minority were clinically diagnosed with chronic obstructive pulmonary disease (5.4%), asthma (10.8%), or interstitial lung disease (2.7%). 

“Despite 86.5% of subjects reporting no or only slight dyspnea (MRC grade 0 or 1), 29.7% had evidence of parenchymal disease, 59.5% had evidence of airway disease, and 62.2% had pulmonary nodules on HRCT,” the investigators found. “Semiquantitative HRCT scoring revealed most airway and parenchymal abnormalities to be mild in severity. Similarly, physiologic impairment on PFTs was infrequent, with 16.2% demonstrating restrictive and 18.9% obstructive spirometry.”

Among the 27 patients who completed 1 year of follow-up, no significant change in the PFT parameters (FEV1, FVC, TLC, DLCO) or MRC score was seen. “Stability in PFTs was present even among RA patients with detectable lung disease on HRCT. Baseline DAS28-ESR was negatively correlated with FVC (r = -0.42, p = 0.01) and positively correlated with MRC scores (r=0.57, p< 0.001), but not with other PFT parameters or with HRCT findings,” the researchers noted. Seropositivity for RF or anti-CCP antibodies was not associated with increase in airway or parenchymal abnormalities.

"In this prospective cohort of patients with recently-diagnosed RA who underwent systematic evaluation for lung disease, airway and parenchymal abnormalities were commonly detected on HRCT but mild in severity. Pulmonary nodules were the most detected HRCT finding,” the authors stated. “Physiologic impairment was infrequent, and the stability of PFTs and dyspnea symptoms early after RA diagnosis is reassuring and may suggest that patients with asymptomatic imaging findings do not require treatment modifications, though longer follow-up periods are needed.”

—Rebecca Mashaw

Reference:
Mahajan T, Hershberger D, Devries M, et al. Prevalence and early progression of lung diseases in patients with recently diagnosed rheumatoid arthritis: a prospective cohort study. Presented at: American College of Rheumatology Convergence 2021; November 5-9, 2021; virtual. Abstract 0574.