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Pathology of Interstitial Lung Disease in Patients with Rheumatoid Arthritis

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Lung Disease Associated with Rheumatoid Arthritis

Abstract

Interstitial lung d isease (ILD) and airway diseases are thought to be important prognostic factors of rheumatoid arthritis (RA). Although the classification used for idiopathic interstitial pneumonias has been applied to describe the histological patterns of RA-ILD, mixtures of these histological patterns, hyperplasia of bronchus-associated lymphoid tissue, and variable bronchiolar diseases complicate a pathological diagnosis. We investigated pathological features of RA-ILD and detected characteristic cystic lesions in the pulmonary lobules of long-standing RA patients with ILD. Cystic lesions in the lung with long-standing RA that were tentatively identified as cystic bronchiolectasis were closely associated with intralobular bronchiolar damage and the subsequent alveolar reconstruction resulting from inflammatory change. Indeterminate peribronchiolar metaplasia and splitting of alveolar walls similar to the conditions observed in patients with emphysema and resulting in cystic changes in lobules were also seen in the lungs of patients with long-standing RA. The exact mechanism of peribronchiolar metaplasia with intralobular cystic alteration in the never smokers with RA still remains to be resolved. Here, we emphasize that intralobular bronchiolar lesion and cystic consequences are important for the prognosis and treatment of RA-ILD.

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Acknowledgment

The author greatly appreciates Dr. Takashi Ogura, Kanagawa Cardiovascular and Respiratory Center; Dr. Hideyasu Sugimoto, Tokushuukai Kamakura General Hospital; Dr. Sinyu Izumi, Respiratory Medicine, National Center for Global Health and Medicine; and Dr. Hitoshi Tokuda, JCHO Tokyo Yamate Medical Center, for their valuable specimens and comments.

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

    Tamiko Takemura M.D., Ph.D.

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  1. Tamiko Takemura M.D., Ph.D.
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Correspondence to Tamiko Takemura 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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Takemura, T. (2018). Pathology of Interstitial Lung Disease in Patients with 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_7

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