Rheumatoid Arthritis-Associated Interstitial Lung Disease The Relevance of Histopathologic and Radiographic Pattern
Rheumatoid Arthritis-Associated Interstitial Lung Disease The Relevance of Histopathologic and Radiographic Pattern
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DOI：
10.1378/chest.09-0444
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发表时间：
2009-11-01
期刊：
影响因子：
9.6
通讯作者：
King, Talmadge E., Jr.
中科院分区：
文献类型：
--
作者：
Kim, Eunice J.;Collard, Harold R.;King, Talmadge E., Jr.
间质性肺病（ILD）是类风湿关节炎（RA）的常见关节外表现。虽然非特异性间质性肺炎模式在大多数形式的结缔组织相关ILD中占主导地位，但在RA相关ILD（RA-ILD）患者中进行的研究表明，普通间质性肺炎（UIP）模式在该患者人群中更常见。高分辨率CT（HRCT）扫描在识别许多RA-ILD患者的UIP模式方面似乎是准确的。尽管数据有限，但UIP模式似乎预测RA-ILD患者的生存率更差。需要更大的、前瞻性的、多中心的研究来证实这一发现。我们建议对RA-ILD患者的评估应侧重于识别HRCT扫描上具有UIP模式的患者，因为这些患者可能预后较差。对于HRCT扫描不能确定潜在模式的患者，应考虑手术肺活检。（CHEST 2009; 136：1397-1405）
Interstitial lung disease (ILD) is a frequent extraarticular manifestation of rheumatoid arthritis (RA). While the nonspecific interstitial pneumonia pattern predominates in most forms of connective tissue-associated ILD, studies in patients with RA-associated ILD (RA-ILD) suggest that the usual interstitial pneumonia (UIP) pattern is more common in this patient population. High-resolution CT (HRCT) scans appear accurate in identifying UIP pattern in many patients with RA-ILD. Although the data are limited, UIP pattern appears to predict worse survival in RA-ILD patients. Larger, prospective, multicenter studies are needed to confirm this finding. We propose that the evaluation of patients with RA-ILD should focus on identifying those with UIP pattern on HRCT scans, as these patients are likely, to carry a worse prognosis. In patients in whom the underlying pattern cannot be determined by HRCT scanning, surgical lung biopsy should be considered. (CHEST 2009; 136:1397-1405)