Pulmonary involvement in rheumatoid arthritis: evaluation by radiography and spirometry

Abstract

Objective: To determine whether simple diagnostic methods can yield relevant disease information in patients with rheumatoid arthritis (RA). Methods: Patients with RA were randomly selected for inclusion in a cross-sectional study involving clinical evaluation of pulmonary function, including pulse oximetry (determination of SpO2, at rest), chest X-ray, and spirometry. Results: A total of 246 RA patients underwent complete assessments. Half of the patients in our sample reported a history of smoking. Spirometry was abnormal in 30% of the patients; the chest X-ray was abnormal in 45%; and the SpO2 was abnormal in 13%. Normal chest X-ray, spirometry, and SpO2 were observed simultaneously in only 41% of the RA patients. A history of smoking was associated with abnormal spirometry findings, including evidence of obstructive or restrictive lung disease, and with abnormal chest X-ray findings, as well as with an interstitial pattern on the chest X-ray. Comparing the patients in whom all test results were normal (n = 101) with those in whom abnormal test results were obtained (n = 145), we found a statistically significant difference between the two groups, in terms of age and smoking status. Notably, there were signs of airway disease in nearly half of the patients with minimal or no history of tobacco smoke exposure. Conclusions: Pulmonary involvement in RA can be identified through the use of a combination of diagnostic methods that are simple, safe, and inexpensive. Our results lead us to suggest that RA patients with signs of lung involvement should be screened for lung abnormalities, even if presenting with no respiratory symptoms.

Large airway ventilatory functions in female patients of rheumatoid arthritis with methotrexate therapy- is there any change?

“…In the present study, we found significantly lowered FVC, FEV 1 and PEFR in RA patients at baseline (before MTX therapy) than those of control group. Similar findings were observed by several investigators 5,8,25,30 . The cause of our finding might be due to movement limitation of chest cage,because of synovial joint affection (specially, costovertebral and costochondral) [33][34] or respiratory muscle weakness 13, 33-35[43] or inflammatory change in the bronchi 13,29,[33][34] in RA.…”

“…Significantly lower mean percentages of predicted value of FVC in RA patients without [5][6][24][25] and after low dose MTX therapy have been reported [26][27] . On the other hand, non-significant decrease in FVC value after MTX treatment in patients with RA has also been published [28][29] .…”

A Comparative Study of Pulmonary Involvement in Patients With Rheumatoid Arthritis

“…Alexandre Melo Kawassaki et al 20 observed the chest X-rays were normal (55.3%) of the patients; hyperinflation was present in (24.8%); the interstitial pattern was observed in (14.6%); volume loss was observed in (2.4%) and miscellaneous abnormalities were observed in the remaining (2.8%).…”

Relationship Between Smoking and Structural Damage, Autoimmune Antibodies, and Disability in Rheumatoid Arthritis Patients

“…They reported that smoking or methotrexate may be a risk factor for pulmonary disease. Moreover, Kawassaki et al 31 investigated pulmonary disease in patients with RA and found that lung involvement was related to smoking. In our study, lung involvement was determined in 40 patients out of 165 (24.2%).…”