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Radiological Characteristics of Interstitial Lung Diseases in Patients with Connective Tissue Disease: Focus on Rheumatoid Arthritis

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Lung Disease Associated with Rheumatoid Arthritis

Abstract

Impairments/comorbidities of the respiratory system are important extra-articular features in patients with rheumatoid arthritis (RA) and represent a major cause of mortality. Interstitial lung disease (ILD) in RA (RA-ILD) and other types of connective tissue diseases (CTDs) is categorized using the international consensus classification of an idiopathic interstitial pneumonia. Unlike other types of CTDs, RA-ILD most often shows a usual interstitial pneumonia-like pattern on high-resolution computed tomography (HRCT), and less often, it displays patterns of nonspecific interstitial pneumonia, organizing pneumonia (OP), diffuse alveolar damage, and variants of OP. In addition, airway impairment (including bronchiectasis, follicular bronchiolitis, and bronchiolitis obliterans) and pleural disease are well-known comorbidities in patients with RA. In clinical practice, these lung lesions are problematic, because they are often difficult to distinguish from pulmonary infections and drug-induced lung injury. This chapter describes CTD-ILDs and mainly focuses on RA-ILD. HRCT images and histopathological patterns are reviewed and illustrated. Acute exacerbations of CTD-ILD/RA-ILD and ILDs that precede CTDs are also discussed.

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Acknowledgment

The author greatly appreciate Dr. Masaki Okamoto and Dr. Shinjiro Kaieda, Department of Medicine, Division of Respirology, Neurology, and Rheumatology, Kurume University School of Medicine; and Dr. Mikiko Hashisako and Prof. Junya Fukuoka, Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences for their helpful advices and valuable illustrations of radiologic and histologic findings.

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Authors and Affiliations

  1. Department of Radiology, Kurume University School of Medicine, Kurume, Japan

    Kiminori Fujimoto M.D., Ph.D.

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  1. Kiminori Fujimoto M.D., Ph.D.
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Correspondence to Kiminori Fujimoto M.D., Ph.D. .

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Editors and Affiliations

  1. Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan

    Takahisa Gono

  2. Department of Respiratory Medicine, JCHO Tokyo Yamate Medical Center, Tokyo, Japan

    Hitoshi Tokuda

  3. Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan

    Fumikazu Sakai

  4. Department of Pathology , Japanese Red Cross Medical Center, Tokyo, Japan

    Tamiko Takemura

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Fujimoto, K. (2018). Radiological Characteristics of Interstitial Lung Diseases in Patients with Connective Tissue Disease: Focus on Rheumatoid Arthritis. In: Gono, T., Tokuda, H., Sakai, F., Takemura, T. (eds) Lung Disease Associated with Rheumatoid Arthritis. Springer, Singapore. https://doi.org/10.1007/978-981-10-6750-1_8

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  • DOI: https://doi.org/10.1007/978-981-10-6750-1_8

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