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. 2023 Nov 11;12(22):7041.
doi: 10.3390/jcm12227041.

Fibrosing Progressive Interstitial Lung Disease in Rheumatoid Arthritis: A Multicentre Italian Study

Marco Sebastiani  1 , Vincenzo Venerito  2 , Elenia Laurino  3 , Stefano Gentileschi  4 , Fabiola Atzeni  5 , Claudia Canofari  6 , Dario Andrisani  7 , Giulia Cassone  1 , Marlea Lavista  2 , Francesco D'Alessandro  3 , Caterina Vacchi  1 , Arnaldo Scardapane  8 , Bruno Frediani  4 , Massimiliano Cazzato  3 , Carlo Salvarani  9 , Florenzo Iannone  2 , Andreina Manfredi  1
Affiliations

Fibrosing Progressive Interstitial Lung Disease in Rheumatoid Arthritis: A Multicentre Italian Study

Marco Sebastiani et al. J Clin Med. .

Abstract

Background: The INBUILD study demonstrated the efficacy of nintedanib in the treatment of progressive fibrosing interstitial lung disease different to idiopathic pulmonary fibrosis, including rheumatoid arthritis (RA)-related ILD. Nevertheless, the prevalence of RA-ILD patients that may potentially benefit from nintedanib remains unknown.

Objectives and methods: The aim of the present multicentre study was to investigate the prevalence and possible associated factors of fibrosing progressive patterns in a cross-sectional cohort of RA-ILD patients.

Results: One hundred and thirty-four RA-ILD patients with a diagnosis of RA-ILD, who were confirmed at high-resolution computed tomography and with a follow-up of at least 24 months, were enrolled. The patients were defined as having a progressive fibrosing ILD in case of a relative decline in forced vital capacity > 10% predicted and/or an increased extent of fibrotic changes on chest imaging in a 24-month period. Respiratory symptoms were excluded to reduce possible bias due to the retrospective interpretation of cough and dyspnea. According to radiologic features, ILD was classified as usual interstitial pneumonia (UIP) in 50.7% of patients, nonspecific interstitial pneumonia in 19.4%, and other patterns in 29.8%. Globally, a fibrosing progressive pattern was recorded in 36.6% of patients (48.5% of patients with a fibrosing pattern) with a significant association to the UIP pattern.

Conclusion: We observed that more than a third of RA-ILD patients showed a fibrosing progressive pattern and might benefit from antifibrotic treatment. This study shows some limitations, such as the retrospective design. The exclusion of respiratory symptoms' evaluation might underestimate the prevalence of progressive lung disease but increases the value of results.

Keywords: high-resolution computed tomography; interstitial lung disease (ILD); nintedanib; progressive fibrosing ILD; rheumatoid arthritis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Interstitial lung disease behavior. Schematic representation of the frequencies of ILD progression patterns among the patients enrolled in the study.
See this image and copyright information in PMC

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