Screening for ILD in RA

Patients with rheumatoid arthritis (RA) with risk factors for interstitial lung disease (ILD) or pulmonary symptoms should be evaluated for ILD at baseline RA diagnosis1,2

Julie

RISK FACTORS FOR DEVELOPMENT OF ILD NEED TO BE ASSESSED AT BASELINE RA DIAGNOSIS1,2

Up to 30% of RA patients are affected by ILD1,3-6

Risk factors for development of ILD in patients with RA

Age
  • >60 years7

Sex
Lifestyle
Serological
Clinical
  • Longer disease duration17

  • Higher disease activity1,11,18

  • Decreased functional status1,18

  • Presence of extra-articular manifestations (e.g. rhuematoid nodules)18

  • Elevated ESR15,18

 

Despite RA-ILD being common in patients in their 40s to 50s, patients aged >60 years are at increased risk of developing ILD5,7

  • For each 10-year age increase, the likelihood of ILD increases by 64%15

RA-ILD is approximately four times more common in men than in women.1,8

Smoking increases the risk of ILD in patients with RA,6,9 but it is important to note that RA-ILD can occur in non-smokers too.19

Positive serologies for either RF or anti-CCP antibody are significant predictors for development of ILD in patients with RA.6,10–14

 

 

RA PATIENTS WITH RISK FACTORS FOR ILD OR PRE-EXISTING PULMONARY SYMPTOMS AT BASELINE RA DIAGNOSIS SHOULD BE EVALUATED FOR ILD1,2

Early assessment for ILD using baseline PFTs and HRCT is reasonable to identify ILD in RA1

A history of smoking in a patient with RA-ILD should lead to investigation with a chest X-ray and spirometry in the first instance20

Listening for crackles on lung auscultation may be a useful screen for subclinical ILD in patients with RA, inviting comprehensive lung function assessment20,21

Suggested algorithm to identify RA-ILD in patients with RA1
Algorithm to determine how ILD is identified in RA patients through clinical symptoms / HRCT / PFT

Adapted from: Espositto AJ, et al. Clln Chest Med. 2019;40:545-580.

RAILD PC

Julie has RA-ILD

How can you reach an RA-ILD diagnosis?

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Footnotes
  • CCP, cyclic citrullinated peptide; CT, computed tomography; CTD-ILD, connective tissue disease-associated interstitial lung disease; DLCO, diffusing capacity of the lung for carbon monoxide; ESR, erythrocyte sedimentation rate; HRCT, high-resolution computed tomography; ILD, interstitial lung disease; KL-6, Krebs von den Lungen-6; PFT, pulmonary function test; RA; rheumatoid arthritis; RA-ILD, rheumatoid arthritis-associated interstitial lung disease; RF, rheumatoid factor.

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  10. Mori S, Koga Y, Sugimoto M. Different risk factors between interstitial lung disease and airway disease in rheumatoid arthritis. Respir Med. 2012;106(11):1591–1599.
  11. Habib HM, Eisa AA, Arafat WR, et al. Pulmonary involvement in early rheumatoid arthritis patients. Clin Rheumatol. 2011;30:217–221.
  12. Doyle TJ, Patel AS, Hatabu H, et al. Detection of rheumatoid arthritis–interstitial lung disease is enhanced by serum biomarkers. Am J Respir Crit Care Med. 2015;191(12):1403–1412.
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  14. Yin Y, Liang D, Zhao L, et al. Anti-cyclic citrullinated Peptide antibody is associated with interstitial lung disease in patients with rheumatoid arthritis. PLoS One. 2014;9(4):e92449.
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  17. Ha YJ, Lee YJ, Kang EH. Lung involvements in rheumatic diseases: update on the epidemiology, pathogenesis, clinical features, and treatment. Biomed Res Int. 2018:6930297.
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  19. Ayhan-Ardic FF, Oken O, Yorgancioglu ZR, et al. Pulmonary involvement in lifelong non-smoking patients with rheumatoid arthritis and ankylosing spondylitis without respiratory symptoms. Clin Rheumatol. 2006;24:213–218.
  20. Lake F and Proudman S. Rheumatoid arthritis and lung disease: from mechanisms to a practical approach. Semin Respir Crit Care Med. 2014;35(2):222–238.
  21. Cottin V and Cordier JF. Subclinical interstitial lung disease: no place for crackles? Am J Respir Crit Care Med. 2012;186(3):289–290.
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  28. Wijsenbeek M, Cottin V. Spectrum of Fibrotic Lung Diseases. N Engl J Med. 2020;383:958–968.

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