Pulmonary Manifestations in Rheumatoid Arthritis: A Prospective Study of Prevalence, Risk Factors, and Treatment Outcomes
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Abstract
Aims: Current screening paradigms for RA-associated lung disease lack validated serologic thresholds, while treatment remains guideline-agnostic with limited comparative effectiveness data. This prospective study aimed to: (1) establish clinically actionable risk thresholds (anti-CCP, DAS-28), (2) characterize HRCT patterns, and (3) compare mycophenolate vs conventional immunosuppressants. This study aimed to characterize pulmonary involvement in RA, identify ILD risk factors, and assess 6-month treatment outcomes to address these unmet needs. Methods: This prospective observational study (2019-2021) enrolled 65 RA patients (ACR/EULAR criteria) with pulmonary symptoms at a tertiary center. Comprehensive evaluation included HRCT (UIP/NSIP patterns), PFTs, 6-minute walk test (6MWT), DAS-28 scoring, and serology (RF/anti-CCP). Statistical analysis used Mann-Whitney and Pearson χ² tests. Results: - ILD prevalence: 40% (UIP:76.9%, NSIP:23%); bronchiectasis:21.5%; pleural effusion: 21.5%.
- Significant predictors:
- Age >50 years (OR 3.2, p<0.01);
- RA duration >8 years (OR 4.1, p<0.001)
- Anti-CCP >150 U/ml (OR 5.6, p<0.001)
- DAS-28 >5.1 (OR 3.8, p=0.002)
- Mortality: 19.2% in ILD vs 2.5% non-ILD (p=0.037)
- 6MWT: 26.2% desaturation at baseline
- Treatment: Mycophenolate mofetil superior to cyclophosphamide/corticosteroids (p=0.004)
Conclusions: This study confirms the high burden of pulmonary disease in RA (particularly UIP-pattern ILD) and provides actionable thresholds for risk stratification (anti-CCP >150 U/ml, DAS-28 >5.1). Mycophenolate mofetil emerges as a preferred therapeutic option, supporting the need for revised management guidelines.
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Copyright (c) 2025 Archana Sonawale, Ishita Lanjewar, Kshitij Sonawale, Alhad Mulkalwar, Kashika Vats
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