Obliterative bronchiolitis associated with rheumatoid arthritis: Analysis of a single-center case series

Erica Lin, Andrew Harold Limper, Teng Moua

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Rheumatoid arthritis (RA) is a systemic autoimmune condition characterized by erosive inflammation of the joints. One rare pulmonary manifestation is obliterative bronchiolitis (OB), a small airways disease characterized by the destruction of bronchiolar epithelium and airflow obstruction. Methods: We retrospectively reviewed the clinical data of patients with rheumatoid arthritis-associated obliterative bronchiolitis (RA-OB) from 01/01/2000 to 12/31/2015. Presenting clinical features, longitudinal pulmonary function testing, radiologic findings, and independent predictors of all-cause mortality were assessed. Results: Forty one patients fulfilled criteria for diagnosis of RA-OB. There was notable female predominance (92.7%) with a mean age of 57 ± 15 years. Dyspnea was the most common presenting clinical symptom. Median FEV1 was 40% (IQR 31-52.5) at presentation, with a mean decline of - 1.5% over a follow-up period of thirty-three months. Associated radiologic findings included mosaic attenuation and pulmonary nodules. A majority of patients (78%) received directed therapy including long-acting inhalers, systemic corticosteroids or other immunosuppressive agents, and macrolide antibiotics. All-cause mortality was 27% over a median follow-up of sixty-two months (IQR 32-113). No distinguishable predictors of survival at presentation were found. Conclusions: RA-OB appears to have a stable clinical course in the majority of patients despite persistent symptoms and severe obstruction based on presenting FEV1.

Original languageEnglish (US)
Article number105
JournalBMC Pulmonary Medicine
Volume18
Issue number1
DOIs
StatePublished - Jun 22 2018

Fingerprint

Bronchiolitis
Rheumatoid Arthritis
Lung
Mortality
Nebulizers and Vaporizers
Macrolides
Immunosuppressive Agents
Dyspnea
Adrenal Cortex Hormones
Epithelium
Joints
Anti-Bacterial Agents
Inflammation
Survival
Therapeutics

Keywords

  • Obliterative bronchiolitis
  • Rheumatoid arthritis
  • Small airways disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Obliterative bronchiolitis associated with rheumatoid arthritis : Analysis of a single-center case series. / Lin, Erica; Limper, Andrew Harold; Moua, Teng.

In: BMC Pulmonary Medicine, Vol. 18, No. 1, 105, 22.06.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Rheumatoid arthritis (RA) is a systemic autoimmune condition characterized by erosive inflammation of the joints. One rare pulmonary manifestation is obliterative bronchiolitis (OB), a small airways disease characterized by the destruction of bronchiolar epithelium and airflow obstruction. Methods: We retrospectively reviewed the clinical data of patients with rheumatoid arthritis-associated obliterative bronchiolitis (RA-OB) from 01/01/2000 to 12/31/2015. Presenting clinical features, longitudinal pulmonary function testing, radiologic findings, and independent predictors of all-cause mortality were assessed. Results: Forty one patients fulfilled criteria for diagnosis of RA-OB. There was notable female predominance (92.7{\%}) with a mean age of 57 ± 15 years. Dyspnea was the most common presenting clinical symptom. Median FEV1 was 40{\%} (IQR 31-52.5) at presentation, with a mean decline of - 1.5{\%} over a follow-up period of thirty-three months. Associated radiologic findings included mosaic attenuation and pulmonary nodules. A majority of patients (78{\%}) received directed therapy including long-acting inhalers, systemic corticosteroids or other immunosuppressive agents, and macrolide antibiotics. All-cause mortality was 27{\%} over a median follow-up of sixty-two months (IQR 32-113). No distinguishable predictors of survival at presentation were found. Conclusions: RA-OB appears to have a stable clinical course in the majority of patients despite persistent symptoms and severe obstruction based on presenting FEV1.",
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N2 - Background: Rheumatoid arthritis (RA) is a systemic autoimmune condition characterized by erosive inflammation of the joints. One rare pulmonary manifestation is obliterative bronchiolitis (OB), a small airways disease characterized by the destruction of bronchiolar epithelium and airflow obstruction. Methods: We retrospectively reviewed the clinical data of patients with rheumatoid arthritis-associated obliterative bronchiolitis (RA-OB) from 01/01/2000 to 12/31/2015. Presenting clinical features, longitudinal pulmonary function testing, radiologic findings, and independent predictors of all-cause mortality were assessed. Results: Forty one patients fulfilled criteria for diagnosis of RA-OB. There was notable female predominance (92.7%) with a mean age of 57 ± 15 years. Dyspnea was the most common presenting clinical symptom. Median FEV1 was 40% (IQR 31-52.5) at presentation, with a mean decline of - 1.5% over a follow-up period of thirty-three months. Associated radiologic findings included mosaic attenuation and pulmonary nodules. A majority of patients (78%) received directed therapy including long-acting inhalers, systemic corticosteroids or other immunosuppressive agents, and macrolide antibiotics. All-cause mortality was 27% over a median follow-up of sixty-two months (IQR 32-113). No distinguishable predictors of survival at presentation were found. Conclusions: RA-OB appears to have a stable clinical course in the majority of patients despite persistent symptoms and severe obstruction based on presenting FEV1.

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