Surgical Pathology of Diffuse Parenchymal Lung Disease in Patients with Psoriasis or Psoriatic Arthritis

Yasmeen M. Butt, Maxwell L. Smith, Henry D. Tazelaar, Anja C. Roden, Maria Cecilia Mengoli, Brandon T. Larsen

Research output: Contribution to journalArticlepeer-review

Abstract

Context.—Diffuse parenchymal lung disease (DPLD) is a well-recognized complication of systemic connective tissue disease (CTD) but rarely arises in patients with psoriasis or psoriatic arthritis, a poorly understood phenomenon. Objective.—To characterize DPLD associated with psoriasis or psoriatic arthritis, with or without prior immunomodulation. Design.—Pathology consultation files were searched for patients having psoriasis or psoriatic arthritis and DPLD. After excluding cases with active infection or smoking-related DPLD only, 44 patients (22 women; median age, 60 years; range, 23–81 years) were enrolled. Clinical history and pathology slides were reviewed. Results.—Twenty-seven of 44 patients (61%) had psoriatic arthritis; the remainder had psoriasis alone. Most presented many years later with nonspecific respiratory symptoms. Nearly one-third had no prior immunosuppression, and most had no concomitant CTD. Radiographically, ground-glass opacities, consolidation, and/or reticulation were typical. Histologically, nonspecific interstitial pneumonia and unclassifiable fibrosis were seen in 24 patients (55%) and 8 patients (18%), respectively; usual interstitial pneumonia and airway-centered fibrosis were rare. Superimposed acute lung injury was common, usually manifesting as organizing pneumonia. Lymphoplasmacytic infiltrates, lymphoid aggregates, and chronic pleuritis were frequent. Interstitial granulomas were seen in 17 patients (39%) but were usually rare, poorly formed, and nonnecrotizing. No histologic differences were apparent among patients with or without concomitant CTDs or prior therapy. Conclusions.—Some patients with psoriasis or psoriatic arthritis develop clinically significant DPLD, even without prior therapy. Histopathologic findings mirror changes seen with other CTDs. Additional studies are warranted to clarify the association between psoriasis or psoriatic arthritis and DPLD.

Original languageEnglish (US)
Pages (from-to)525-533
Number of pages9
JournalArchives of Pathology and Laboratory Medicine
Volume147
Issue number5
DOIs
StatePublished - May 2023

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

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