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

Area of Science:

• Pulmonology
• Rheumatology
• Radiology

Background:

• Nintedanib is effective for progressive fibrosing interstitial lung disease (PF-ILD) beyond idiopathic pulmonary fibrosis.
• Rheumatoid arthritis-associated ILD (RA-ILD) is one such condition where nintedanib may be beneficial.
• The prevalence of progressive fibrosing patterns in RA-ILD patients is currently unknown.

Purpose of the Study:

• To determine the prevalence of fibrosing progressive patterns in RA-ILD patients.
• To identify factors associated with progressive fibrosing patterns in RA-ILD.

Main Methods:

• A multicentre, cross-sectional study enrolled 134 RA-ILD patients with high-resolution computed tomography confirmation and at least 24 months follow-up.
• Progressive fibrosing ILD was defined by a >10% predicted decline in forced vital capacity and/or increased fibrotic changes on imaging over 24 months.
• Respiratory symptoms were excluded to minimize bias in retrospective analysis.

Main Results:

• A fibrosing progressive pattern was identified in 36.6% of RA-ILD patients.
• The progressive fibrosing pattern was significantly associated with the usual interstitial pneumonia (UIP) radiological pattern (50.7% of cases).
• Among patients with a fibrosing pattern, 48.5% showed progression.

Conclusions:

• Over one-third of RA-ILD patients exhibit a fibrosing progressive pattern, suggesting potential benefit from antifibrotic treatment.
• The study's retrospective design and exclusion of respiratory symptoms are limitations.
• Despite limitations, the findings highlight a significant population of RA-ILD patients who may benefit from antifibrotic therapies.