POS1076 APICAL FIBROSIS AND INTERSTITIAL LUNG DISEASE IN PATIENTS WITH PSORIATIC ARTHRITIS: DO WE UNDERESTIMATE?
Authors: Ayan G. , Ata E. B. , Durhan G. , Ariyurek M. , Kalyoncu U. 
Published: May 2021

Background:

Extra-articular manifestation (EAMs) definition is not clearly defined in psoriatic arthritis (PsA). Nail involvement, enthesitis, dactylitis has been widely studied however, data are needed on pulmonary involvement in PsA.

Objectives:

We aimed to understand real-life results of lung involvement in PsA patients.

Methods:

From the PsA cohort followed in our outpatient clinic, patients who have been requested a chest computed tomography (CT) for any reason by any department were retrieved from medical records and included in this retrospective cross-sectional analysis. All CTs were assessed by a radiologist who is blinded to the patients` clinical history and findings were categorized as parenchymal, airway, pleural findings and lymphadenopathy (LAM). Moreover, any findings that are radiologically attributed to a specific entity such as previous tuberculosis (Tb) infection were noted. Demographic/clinic data including smoking status, concomitant lung problems, disease characteristics (duration, axial/ peripheral involvement) were collected and analyzed.

Results:

A total of 80/1072 (7.4 %; 65% female) PsA patients with mean (SD) age 56.1 (13.2) years were included in the study. Median (IQR) PsA duration was 23.5 (55.75) months and 36 (45%) patients had peripheral, 29 (36.3%) patients had axial involvement. For the rest of 15 (18.7 %) patients, radiographic assessment was missing. Smoking status could be retrieved in 47 patients (never=40.4%, ex-smoker= 19.1%, current smoker=40.4%). There were 14 concomitant lung problem in 12 (15%) patients. CT findings showed that 68.8% of patients had at least one lung pathology. Parenchymal findings were seen in 65% of the patients as both non-spesific changes (atelectasis, n= 35; nodules, n=24; ground glass opacity, n= 9; sequelae fibrosis, n= 9; emphysema, n= 7; consolidation, n= 5, interstitial thickening, n= 5; pulmonary cyst, n =4) and specific pathologies as apical fibrosis (AF) (n=5) and intersititial lung disease (ILD) (n=5, NSIP=3, LIP=2). AF was linked to previous Tb infection in 1 patient and radiotherapy in another (Table 1). However, there is no specific pathology in the rest of 3 (3.7%) patients that AF could be attributed to and all of them were male. Other pathologies were seen as airway findings in 28.8% patients (bronchiectasis, n= 17, bronchial wall thickness, n= 10, air trapping n= 7, centrilobular opacity, n= 4,) and pleural findings in 13.8 % of the patients (pleural plaque, n= 5, effusion, n= 3, thickness, n=3). LAM was observed in around 4% of the patients.

Table 1.

Patient characteristics with apical fibrosis, interstitial lung disease

InvolvementGenderAgePsA duration, monthsAxial
Disease
(yes/no)Smoking
StatusSmoking package-yearsConcomitant
Lung Disease
(yes/no)Linked to
another problem
by radiologist
(yes/no)ID-1AFM582NoCurrent40NoNoID-2AFM611NoCurrent40NoNoID-3AFM73122YesEx30NoNoID-4AFF551YesNANANoYes*ID-5AFF65#NANever-Yes€Yes€ID-6NSIPF96NANANever-NoNoID-7NSIPM69NANAEx15Yes$NoID-8NSIPF66156NoNANAYes$NoID-9LIPM61200YesNever-NoNoID-10LIPF8014YesNANANoNo

AF= Apical fibrosis; NSIP= Non-spesific interstitial pneumonia, LIP= Lymphocytic interstitial pneumonia; PsA= Psoriatic Arthritis, NA= Not available*radiotherapy sequelae; # tomography was done prior to PsA diagnosis; € previous tuberculosis infection; $ chronic obstructive pulmonary disease

Conclusion:

The real-life experience of our PsA cohort showed that pulmonary findings included variable spesific, non-spesific findings. As a limitation results represent the CT findings of around 8% of our PsA cohort. Within the scope of previous reports male predominant AF and ILD come forward in PsA that requires further attention in future studies [1,2].

References:

[1]Peluso R, Iervolino S, Vitiello M, et al (2015) Extra-articular manifestations in psoriatic arthritis patients. Clin Rheumatol 34 (4):745-753.

[2]Bargagli E, Bellisai F, Mazzei MA, et al (2020) Interstitial lung disease associated with psoriatic arthritis: a new disease entity? Intern Emerg Med.

Disclosure of Interests:

None declared.