Scott M Matson, Jiwoong Choi, Drayton Rorah, Shamir Khan, Anna Trofimoff, Taewon Kim, David H Lee, Asma Abdolijomoor, Maggie Chen, Imaan Azeem, Linh Ngo, Tami J Bang, Peter Sachs, Kevin D Deane, M Kristen Demoruelle, Mario Castro, Joyce S Lee
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Of lung involvement in RA, interstitial lung disease (ILD) is well known; however, airways disease in RA is relatively understudied.</p><p><strong>Research question: </strong>What are the baseline airways abnormalities in a prospective cohort of patients with RA based on pulmonary function testing (PFT) results, high-resolution CT (HRCT) scans, and computational imaging analysis and are there associations between these abnormalities and respiratory symptoms?</p><p><strong>Study design and methods: </strong>In this single-center study, 188 patients with RA without a clinical diagnosis of ILD underwent HRCT imaging and PFT. Radiologists assessed HRCT scans for airway abnormalities. Computational imaging via VIDA Vision software and in-house quantitative CT imaging analysis was applied to 147 HRCT scans to quantify airway abnormalities.</p><p><strong>Results: </strong>Airways obstruction (FEV<sub>1</sub> to FVC ratio < 0.7) was present in 20.7% of patients and was associated with older age, male sex, and higher smoking rate. Radiologists identified airway abnormalities in 61% of patients: 55% had bronchial wall thickening, 12% had bronchiectasis, and 5% had mosaic attenuation. These airways findings were associated with older age; male sex; lower FEV<sub>1</sub>, FVC, and FEV<sub>1</sub> to FVC ratio; and higher rates of rheumatoid factor positivity. Prespecified quantitative CT scan metrics (wall thickening percentage and emphysema percentage) correlated with obstruction in PFT results and more severe respiratory symptoms, including shortness of breath and cough.</p><p><strong>Interpretation: </strong>High rates of airways abnormalities were found in this prospective RA cohort based on three methods of detection. Significant associations were identified between quantitative CT scan measures and respiratory symptoms. 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引用次数: 0
摘要
背景：类风湿性关节炎（RA）患者约占总人口的 1%，通常累及肺部。在类风湿关节炎累及的肺部疾病中，间质性肺病（ILD）是众所周知的；然而，对类风湿关节炎患者气道疾病的研究却相对不足：研究问题：根据肺功能测试（PFT）、高分辨率 CT 扫描（HRCT）和计算成像分析，前瞻性队列中的 RA 患者有哪些基线气道异常？在这项单中心研究中，188 名未被临床诊断为 ILD 的 RA 患者接受了 HRCT 和 PFT 检查。放射科医生对 HRCT 进行评估，以发现气道异常。通过 VIDA Vision 软件和内部定量 CT（qCT）分析对 147 张 HRCT 进行计算成像，以量化气道异常：结果：20.7%的患者存在气道阻塞（FEV1/FVC 比值小于 0.7），且与年龄较大、男性和吸烟率较高有关。放射科医生在61%的患者中发现了气道异常--55%的患者支气管壁增厚，12%的患者支气管扩张，5%的患者出现镶嵌衰减；这些气道异常与患者年龄偏大、性别为男性、较低的FEV1、FVC、FEV1/FVC比值和较高的类风湿因子阳性率有关。预设的 qCT 指标（管壁增厚率和肺气肿率）与 PFT 阻塞和更严重的呼吸道症状（包括气短和咳嗽）相关：根据三种检测方法，这一前瞻性 RA 队列中气道异常的发生率很高。qCT指标与呼吸道症状之间存在明显关联。气道疾病可能是一种未被充分认识的RA关节外表现，而qCT可能是检测呼吸道症状临床影响的一种敏感方法。
Airways Abnormalities in a Prospective Cohort of Patients With Rheumatoid Arthritis.
Background: Rheumatoid arthritis (RA) affects roughly 1% of the population and commonly involves the lungs. Of lung involvement in RA, interstitial lung disease (ILD) is well known; however, airways disease in RA is relatively understudied.
Research question: What are the baseline airways abnormalities in a prospective cohort of patients with RA based on pulmonary function testing (PFT) results, high-resolution CT (HRCT) scans, and computational imaging analysis and are there associations between these abnormalities and respiratory symptoms?
Study design and methods: In this single-center study, 188 patients with RA without a clinical diagnosis of ILD underwent HRCT imaging and PFT. Radiologists assessed HRCT scans for airway abnormalities. Computational imaging via VIDA Vision software and in-house quantitative CT imaging analysis was applied to 147 HRCT scans to quantify airway abnormalities.
Results: Airways obstruction (FEV1 to FVC ratio < 0.7) was present in 20.7% of patients and was associated with older age, male sex, and higher smoking rate. Radiologists identified airway abnormalities in 61% of patients: 55% had bronchial wall thickening, 12% had bronchiectasis, and 5% had mosaic attenuation. These airways findings were associated with older age; male sex; lower FEV1, FVC, and FEV1 to FVC ratio; and higher rates of rheumatoid factor positivity. Prespecified quantitative CT scan metrics (wall thickening percentage and emphysema percentage) correlated with obstruction in PFT results and more severe respiratory symptoms, including shortness of breath and cough.
Interpretation: High rates of airways abnormalities were found in this prospective RA cohort based on three methods of detection. Significant associations were identified between quantitative CT scan measures and respiratory symptoms. Airways disease may be an underrecognized extra-articular manifestation of RA and quantitative CT imaging may be a sensitive method to detect the clinical impact on respiratory symptoms.
期刊介绍：
At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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