Patients With Psoriasis or Psoriatic Arthritis May Develop Diffuse Parenchymal Lung Disease

According to a study published in the Archives of Pathology & Laboratory Medicine, some patients with psoriasis (PsO) or psoriatic arthritis (PsA) develop diffuse parenchymal lung disease (DPLD), including those without prior therapy.

Researchers searched for patients with PsO or PsA in addition to DPLD via pathology consultation files. They excluded cases associated with active infection or smoking related DPLD. A total of 44 patients were enrolled of which 22 were women with a median age of 60 years (range 23–81 years). They reviewed clinical history and pathology slides.

Twenty-seven out of the 44 patients had PsA and the other 17 had psoriasis alone. Most of them presented with nonspecific respiratory symptoms many years later. Roughly one-third had no prior immunosuppression, with a majority having no concomitant connective tissue disease (CTD). Notably, 55% of patients with PsA and 18% of patients with PsO showed histologically nonspecific interstitial pneumonia and unclassifiable fibrosis. Interstitial pneumonia and airway-centered fibrosis rarely presented. Additionally, superimposed acute lung injury was commonly seen, manifesting as organizing pneumonia. An additional 39% of patients presented with interstitial granulomas; however, these were usually rare, poorly formed, and nonnecrotizing. There were no histologic differences among patients with or without concomitant CTDs or prior therapy.

“Histopathologic findings mirror changes seen with other CTDs. Additional studies are warranted to clarify the association between psoriasis or psoriatic arthritis and DPLD,” the authors concluded.

Reference
Butt YM, Smith ML, Tazelaar HD, et al. Surgical pathology of diffuse parenchymal lung disease in patients with psoriasis or psoriatic arthritis. Arch Pathol Lab Med. Published online August 2, 2022. doi:10.5858/arpa.2021-0616-OA