類風溼性關節炎合併肺病之臨床特徵評估：台灣單一醫學中心之回顧性研究

Clinical Characteristics of Rheumatoid Arthritis-Associated Lung Disease: A Retrospective Study in a Tertiary Referral Center in Taiwan

Objective: To investigate the clinical characteristics of patients with rheumatoid arthritis (RA)-associatedlung diseases.Methods: A total of 261 patients with RA who were treated with biological agents between August2016 and June 2018 were retrospectively analyzed. Clinical characteristics, serological data, and imageswere collected. RA-associated lung diseases, including pulmonary parenchymal disease [interstitiallung disease (ILD)] and airway disease (bronchiectasis or obliterative bronchiolitis), were identified byone rheumatologist and one pulmonologist. ILD was diagnosed based on the 2013 idiopathic interstitialpneumonias (IIP) classification criteria. The characteristics were compared between two groups of patientswith RA: with and without RA-associated lung diseases.Results: RA-associated lung diseases were detected in 37 (14.1%) of 261 patients with RA. Patientswith RA-associated lung disease were observed to be older and have higher smoking rates and a higherproportion of anti-cyclic citrullinated peptides (anti-CCP) antibody positivity in comparison to thosewithout lung disease (p < 0.05). The highest levels of erythrocyte sedimentation rate (ESR), rheumatoidfactor-IgM, and anti-CCP antibodies during the disease course were also significantly higher in patientswith RA-associated lung disease than in those without lung diseases (p < 0.05).Conclusions: Older patients with RA who smoke and have high levels of RF or anti-CCP antibodiesshould be screened for lung involvement. 目的：探討類風濕性關節炎合併肺部疾病患者的臨床特徵。方法：我們回顧性分析了2016年8月至2018年6月期間曾規則接受生物製劑治療的261名類風濕性關節炎患者，並收集了臨床特徵，血清學數據和影像學特徵。類風濕性關節炎相關肺病包括肺實質疾病（間質性肺病，ILD）和氣道疾病（支氣管擴張或閉塞性細支氣管炎），影像由一名風濕病醫師和一名胸腔科醫師依據2013年特發性間質性肺炎（IIP）分類標準而鑑定分類。我們比較類風濕性關節炎有無合併肺病的兩組之間的臨床特徵。結果：在261名類風濕性關節炎患者中，有37例（14.1%）具有類風濕性關節炎相關肺病。與沒有肺病的患者相比，在類風濕性關節炎相關肺病患者中觀察到發病年齡較大，抽菸比例較高，抗環瓜氨酸肽（CCP）抗體陽性率較高（p值＜0.05），且該病患族群的紅血球沉降率（ESR），類風濕因子和抗CCP抗體的最高值也顯著較高（p值＜0.05）。結論：對於具有較高RF或抗CCP抗體的老年吸菸RA患者，應特別留意篩查肺部病變。