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• W4379801823 abstract "Background Pulmonary rheumatoid nodule(RPN) is an serious extraarticular manifestation of rheumatoid arthritis (RA). The clinical features and activity of the RA, used DMARDs and the characteristics of the nodule may affect the progression of the RPN. [1] Objectives To identify the characteristics of the PRN and factors affecting its progression. Methods In this study, 4117 patients with RA according to the ICD-10 code from the hospital database and who had at least one computed tomography (CT) were identified. The RA diagnosis of the patients were confirmed by examining the medical files (history, physical examination, radiography and laboratory evaluations). Then, chest CTs of the patients with confirmed RA diagnosis were examined by an experienced radiologist. To classify pulmonary nodules as ‘’pulmonary rheumatoid nodule’’, following inclusion and exclusion criteria were used; For inclusion: 1) nodules with changing dimension on follow-up, 2) At least two nodules with different dimensions, 3) Cavitary nodule at any chest CT. For exclusion: 1) Solitary nodules OR all nodules ≤ 5mm and without follow-up OR no change on follow-up. Biggest nodule was named as dominant nodule. Then, patients were grouped according to status of progression. Progression was defined as growth or new nodule formation. Results Of 680 RA patients who had pulmonary nodule in chest CT, 208 (30.6%) patients were classified as having PRN. Of these patients, 135 had at least one control chest CT for PRN follow-up and were included in the study. The median disease duration from diagnosis of RA to baseline CT with PRN was 6.74(0.1-33.9) years. Before the baseline CT, 59 (43.7%) patients were recieving methotrexate and it was discontinued in 22 (37.2%) patients after RPN detection. 39 (28.9%) patients had PRN progression on their final chest CT compared to baseline. The median duration between baseline and final CT was 1.58(0.04-33.81)years. Anti-CCP positivitiy(OR 3.39, %95 CI 1.15-9.94), usage of bDMARDs between baseline and last CT (OR 2.48, %95 CI 1.1-5.5), cavitation (OR 3.31, %95 CI 1.5-7.4) and diameter of dominant nodules at baseline CT (OR 1.03, CI %95 1.00-1.07) were significantly assosiated factors with progression in RPN. Table 1. PRN Progressed (n=39) PRN Non-progressed, n=96 p Female, n(%) 26/39(66.7) 63(65.6) 0.5 Age at the time of CT, med(min-max) 58.3(37.6-79.9) 60(19.5-83.1) 0.4 Time between the diagnoses of RA and RPN, years, med(min-max) 8.92(0.4-24.4) 6.61(0.1-33.9) 0.7 Disease duration, years, med(min-max) 13.1(3.8-32.8) 14.6(0.6-41.2) 0.9 Follow up duration between baseline and last CT,months, med(min-max) 20.1(0.4-124.8) 18.6(0.95-405) 0.2 RF 24/38(63.1) 58/91(63.7) 0.5 CCP 24/29(82.7 ) 41/70(58.5 ) 0.017 Positivite RF or CCP 31/38(81.5) 68/94(72.3) 0.18 Smoking 10/18(55.5) 22/36(61.1) 0.48 Presence of ILD 14/37(37.8) 30/92(32.6) 0.3 Pleural effusion 8/37(21.6) 10/85(11.8) 0.1 Pleural thickening 3/38(7.9) 8/87(9.2) 0.7 Treatments between baseline and last CT, n(%) 0.02 csDMARDs 16(41) 75(78.1) bDMARDs+csDMARDs 26(66.6) 21(21.8) Anti-TNF drugs 9(23) 5(5.2) Non-antiTNF drugs 22(56.4) 23(25.5) Diameter of dominant nodule, med(min-max ) 6.29(2.7-26.1 ) 5.27(3-16 ) 0.03 Number of nodules at baseline, med(min-max ) 8.5(3-82 ) 7(3-40 ) 0.028 Cavitation, 19(48.7 ) 21(21.8 ) 0.002 Calcification, 13(33.3) 26(27) 0.3 Anti-CCP: Anti- Cyclic citrullinated peptide, RF: Rheumatoid Factor, ILD: interstitial lung disease, csDMARDs: conventional synthetic Disease Modifying Anti-Rheumatic Drugs) Conclusion Our study shows that there are multiple factors that predict RPN progression. Especially the presence of cavitary nodules and seropositivity is important.Although clinicians tend to discontinue MTX when RPN is detected, MTX is not associated with RA nodule progression. Reference [1]Karadeniz, H., et al., Treatment with biologic DMARDs may not adversely affect lung nodules in rheumatoid arthritis patients. Eur J Rheumatol, 2022. 9 (2): p. 75-81. Acknowledgements: NIL. Disclosure of Interests None Declared." @default.
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• W4379801823 date "2023-05-30" @default.
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• W4379801823 title "AB0194 PROGRESSION OF RHEUMATOID PULMONARY NODULES: WHAT ARE THE PREDICTIVE FACTORS?" @default.
• W4379801823 doi "https://doi.org/10.1136/annrheumdis-2023-eular.1945" @default.
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