| Objective:To analyze the clinical characteristics,laboratory examinations,high resolution computed tomography(HRCT) features and lung function tests of rheumatoid arthritis(RA)-assosiated interstitial pneumonia(ILD) patients.Methods:All of 786 patients with RA were retrospectively reviewed in department of Rheumatology and Immunology of China-Japan Union Hospital of Jilin University from January 2010 to April 2015.We recorded the age,sex,the duration of rheumatoid arthritis(RA),the duration of interstitial pneumonia(IP),smoking history,joint swelling and pain,morning stiffness,cough,expectoration,chest distress or shortness of breath,exertional dyspnea,clubbing,moist crackles,rheumatoid nodules,Raynaud’s phenomenon,hair loss,dryness of mouth,dryness of eyes,routine blood indexes,liver function test,erythrocyte sedimentation rate(ESR),c-reactive protein(CRP),immunoglobulin A(Ig A),immunoglobulin G(Ig G),immunoglobulin M(Ig M),complement 3(C3),complement 4(C4),rheumatoid factorimmunoglobulin A(RF-Ig A),rheumatoid factor-immunoglobulin G(RF-Ig G),rheumatoid factor-immunoglobulin M(RF-Ig M),anti-cyclic citrullinated peptide antibody(anti-CCP antibody),antinuclear antibody series(ANAs).And we calculated the disease activity score of 28 joints[DAS28(ESR),DAS28 (CRP)],clinical disease activity index(C-DAI),simplifield disease activity index(S-DAI).There were 107 patients diagnosed with RA-ILD among them(excepting eight cases of RA-ILD of infection,bronchiectasis,chronic obstructive pulmonary disease).All of these 107 RA-ILD conducted HRCT and pulmonary function test(PFT):Semiquantitative evaluation of HRCT was performed using Warrick’s score.We collected forced expiratory volume 1 seconds(FEV1),forced vital capacity(FVC),first second forced expiratory volume percentage of forced expiratory volume(FEV1/FVC%),midexpiratory flow at 25 of forced vital capacity/forced expiratory flow at 75 of forced vital capacity(MEF25%/FEF75%),midexpiratory flow at 50 of forced vital capacity/forced expiratory flow at 50 of forced vital capacity(MEF50%/FEF50%),midexpiratory flow at 75 of forced vital capacity/forced expiratory flow at 25 of forced vital capacity(MEF75%/FEF25%),residual volume(RV),total lung capacity(TLC),ratio of residual Volume to total lung capacity(RV/TLC),maximum ventilatory volume(MVV),diffusion capacity for carbon monoxide of the lung(DLCO),carbon monoxide diffusing capacity per liter of alveolar(DLCO/VA).Then we evaluate the relationship between the imaging and functional status of the 107patients;The 786 RA patients were divided into 2 group( group A, without ILD,RA-N-ILD;group B, with ILD,RA-ILD),Then we analyzed the clinical characteristics, laboratory examinations between 2 groups;The 107 RA-ILD patients were divided into subclinical RA-ILD group( group C, without ILD associated clinical signs and symptoms,47 patients) and clinical RA-ILD group(group D, with ILD associated clinical signs and symptoms,60patients),The immune and inflammatory indexes between the 2 groups were analyze.Risk factors were analyzed with logystic regression analysis.Results:1.There were no correlations between the ground-glass opacity score with the items of PFTs(P>0.05).The fibrotic score was negtively correlated with TLC%,RV%,DLCO%,DLCO/VA%(P<0.05).The cysts score was correlated with FVC%,FEV1/FVC%(P<0.05).The HRCT scores was negtively correlated with TLC%,DLCO/VA%(P<0.05).2.(1)Subjects with RA-ILD were older,and had a longer duration of RA compared with subjects with RA-N-ILD(P<0.05).Smoking,history,cough,chest distress or shortness of breath,raynaud’s phenomenon,rheumatoid nodules,moist crackles were significantly higher in group B than group A(P<0.05).⑵WBC,LDH,ALB,ESR,Ig A,C4,anti-CCP antibody were all statistically significant between group A and group B(P<0.05).While Hb,PLT,MPV,PA,TP,GLB,CRP,Ig G,Ig M,C3,RF-Ig A,RF-Ig G and RF-Ig M had no statistical differences between two groups(P>0.05).The stage of hands X-ray in B group(1.90±1.42)was higher than B group(2.27±1.35)(P=0.016).⑶morning stiffness,joint swelling and pain,CRP,DAS28(CRP),DAS28(ESR),S-DAI,C-DAI were not statistical differences between two groups(P>0.05).3.In this study RA-ILD is dependent variables,single factor analysis of variance was used for analyzing means of dates,A p-value less than0.2 was considered statistically significant.The regression modle then used this statistically significant dates as the independent variables There were 7 variables into the regression modle:the age of onset(odds ratio,OR:1.039;95% confidence interval,CI:1.015~1.063),smoking history(OR:0.481;95% CI:0.268~0.865),fever(OR:0.251;95% CI:0.128~0.493),chest distress or shortness of breath(OR:0.317;95% CI:0.158~0.637),moist crackles(OR:0.03;95% CI:0.12~0.72),Raynaud’s phenomenon(OR:0.235;95%CI:0.067~0.825),Ig A(OR:0.035;95% CI:1.041~1.427).The regression equation performs Logit Y(ILD)=0.038X1-0.731X2-1.382X3-1.149X4-3.365X5-1.449X6+0.198X7+2.545.4.(1)Subjects with subclinical RA-ILD were younger,and had a shorter ILD course(the time from the onset of joint symptoms to diagnosis ILD)compared with subjects with clinical RA-ILD(P<0.05).(2)Subjects with subclinical RA-ILD aslo had a trend toward having an increased prealbumin and lower platelet count,erythrocyte sedimentation rate(P<0.05).There were no significant difference(P>0.05) between the 2 groups with regard to the immune and inflammatory indexes of mean platelet volume,globulin,C-reactive protein,immunoglobulin A,immunoglobulin M,immunoglobulin G,complement 3,complement 4,antinuclear antibody series,Ig A,Ig G,Ig M subtypes of rheumatoid factor and anti-cyclic citrullinated peptide antibody.(3)Subjects with subclinical RA-ILD had a significantly lower disease activity of DAS28(CRP),DAS28(ESR),S-DAI,C-DAI than subjects with clinical RA-ILD(P<0.05).Conclusion:1.The HRCT features of pulmonary fibrosis could be used as an evaluation index of pulmonary ventilation and diffusion function.The HRCT features of cysts could be used as an evaluation index of pulmonary ventilation.The total score of HRCT could be used as an evaluation index of pulmonary ventilation and diffusion function.2.The incidence of RA-ILD increase with patients age,the duration of RA.Physicians should pay attention to diagnose RA-ILD in elderly RA patients with longer duration of RA.3.For RA patients with high level of anti-CCP antibody and seriously osteoarticular damages,A close follow-up is required. We should pay more attention to diagnose RA-ILD as early as possible.4.The Logistic regression analysis showed that the age of onset,smoking,fever,Raynaud’s phenomenon,chest distress or shortness of breath, moist crackles,Ig A were relevant factors of RA-ILD.When the older age of onset among RA patients with smoking history developed respiratory symptoms and signs,higher Ig A,We should pay more attention to diagnose RA-ILD. This study first proposed Ig A is a risk factor for RA-ILD.5.Subclinical RA-ILD were easy to miss diagnosis. For young RA patients with low disease activity, without ILD associated clinical signs and symptoms and prolonged course, we should pay more attention.The HRCT and pulmonary function tests should be carried out in these patients. |
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