A Longitudinal Study of Lung Function in Nonsmoking Patients With Rheumatoid Arthritis

Fuld, Jonathan; Johnson, Martin; Cotton, Mark M.; Carter, Roger; Watkin, Simon; Capell, Hilary A.; Stevenson, Robin

doi:10.1378/chest.124.4.1224

Cited by 32 publications

(27 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fuld et al [7] found that the prevalence of pulmonary function abnormalities was higher in asymptomatic rheumatoid patients when compared with the reference population. Avnon et al [8] noted restrictive pulmonary abnormalities in 25.6%, small airway disease in 14.6%, and obstructive in 27%.…”

Section: Discussionmentioning

confidence: 98%

Evaluation of lung function tests in rheumatoid arthritis patients

P¹,

K²,

B³

et al. 2017

Natl J Physiol Pharm Pharmacol

View full text Add to dashboard Cite

Background: Pulmonary manifestation is one of the most common extra-articular features in rheumatoid arthritis (RA) leading to significant morbidity. Lung function testing helps in identifying the type of respiratory defect. Early detection helps in effective management of the lung involvement in RA. Aims and Objectives: In this study, we compared the lung function of RA patient with the normal controls. Materials and Methods: Spirometry was performed in 100 participants (50 RA patients and 50 normal controls). Lung parameters such as forced vital capacity, forced expiratory volume in 1 s, forced expiratory flow in 25-75%, and peak expiratory flow rate were measured. Statistical analysis was performed, P < 0.05 was considered statistically significant. Result: In this study, restrictive ventilatory defect was seen in 64% of patients, and obstructive ventilatory defect was seen in 10% of patients. Pulmonary function abnormalities are common in asymptomatic rheumatoid patients which were found to be restrictive defect. Conclusion: Restrictive ventilatory defect may be due to idiopathic pulmonary fibrosis characterized by high levels of rheumatoid factor, antinuclear antibody and deposits of immunoglobulin A, and complement on the alveolar wall. Screening of RA patients with spirometer helps in early detection of pulmonary involvement.

show abstract

Section: Discussionmentioning

confidence: 98%

Evaluation of lung function tests in rheumatoid arthritis patients

P¹,

K²,

B³

et al. 2017

Natl J Physiol Pharm Pharmacol

View full text Add to dashboard Cite

show abstract

“…In a 10-year follow-up study, Fuld et al [32] showed that PFT abnormality is a common finding in nonsmoking, asymptomatic patients with RA and that its incidence does not increase over time. These data may suggest that obstructive changes in the small airway are simply benign findings, though FEF 25–75 data were available for only a small subset of their patients.…”

Section: Discussionmentioning

confidence: 99%

Small airway obstruction in patients with rheumatoid arthritis

Mori¹,

Koga²,

Sugimoto

2010

Mod Rheumatol

View full text Add to dashboard Cite

This work was intended to evaluate the prevalence of obstructive small-airway disease in patients with rheumatoid arthritis (RA) and its association with clinical characteristics. Pulmonary function testing (PFT) and high-resolution computed tomography (HRCT) were performed on 189 consecutive RA patients. Each case was diagnosed based on abnormal HRCT findings. We defined obstructive dysfunction of small airways as a forced expiratory flow from 25% to 75% of vital capacity (FEF25–75) value >1.96 residual standard deviation (RSD) below predicted values. We found 19 patients (10.1%) with an interstitial pneumonia (IP) pattern and 15 (7.9%) with a bronchiolitis pattern; the other 155 (82.0%) had no abnormal HRCT patterns. In patients with neither abnormal pattern, median values of percentage predicted for carbon monoxide diffusing capacity (DLCO) and ratio of DLCO to alveolar ventilation (DLco/VA) were within the normal range, but median FEF25–75, forced expiratory flow at 25% of vital capacity (V25), and V25/height were <70% of predicted values. Forty-seven patients (30.3%) in this group had obstructive small-airway dysfunction. Multivariate logistic regression analysis indicated that this type of abnormality is strongly associated with respiratory symptoms [odds ratio (OR) 5.18; 95% confidence interval (CI) 1.70–15.75; p = 0.012), smoking history (OR 2.78; 95% CI 1.10–6.99; p = 0.03), and disease duration >10 years (OR 2.86; 95% CI 1.27–6.48; p = 0.012). Parenchymal micronodules, bronchial-wall thickening, and bronchial dilatation on HRCT scans were also predictive factors for abnormal FEF25–75, although these morphological changes were too limited for us to diagnose these patients with the bronchiolitis pattern. Obstructive dysfunction of small airways is apparently common among RA patients, even among those with neither the IP nor the bronchiolitis pattern on HRCT scans. Factors significantly associated with abnormal FEF25–75 are respiratory symptoms, smoking history, and RA duration.

show abstract

“…Hence, airways obstruction (reduced FEV1/FVC) was present in 13.6% of consecutive nonsmoking patients undergoing systematic evaluation in one study [16], and some HRCT abnormalities suggestive of airways disease were present in 34% of patients in another study [8]. The disease course is usually uneventful in poorly symptomatic patients with only mild airflow obstruction and/or isolated bronchiectasis detected by systematic evaluation [17], a condition distinct from that of symptomatic patients with severe OB (as in the present study).…”

Section: Discussionmentioning

confidence: 99%

Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis

Devouassoux

Cottin²,

Lioté³

et al. 2009

European Respiratory Journal

107

View full text Add to dashboard Cite

The characteristics of patients with rheumatoid arthritis (RA) who develop obliterative bronchiolitis characterised by severe airflow obstruction have been hitherto poorly investigated.A retrospective study of 25 patients with RA and functional evidence of obliterative bronchiolitis (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ,50% and/or residual volume (RV)/total lung capacity (TLC) .140% predicted) was conducted.Patients (mean¡SD age 64¡11 yrs) included 17 never-smokers and eight ex-smokers (10.5¡5.4 pack-yrs). The diagnosis of RA preceded respiratory symptoms in 88% of cases. Dyspnoea on exertion was present in all patients and bronchorrhea in 44%. High-resolution computed tomography findings included: bronchial wall thickening (96%), bronchiectasis (40%), mosaic pattern (40%), centrilobular emphysema (56%), and reticular and/or ground-glass opacities (32%). Pulmonary function tests showed: FEV1 41¡12% pred, FEV1/FVC 49¡14%, FVC 70¡20% pred, RV 148¡68% pred and RV/TLC 142¡34% pred. Lung biopsy, available in nine patients, demonstrated constrictive, follicular and mixed bronchiolitis. Patients were followed for 48.2¡49 months. Treatment was poorly effective. Chronic respiratory failure occurred in 40% of patients, and four patients died.Obliterative bronchiolitis associated with rheumatoid arthritis is a severe and under-recognised condition leading to respiratory failure and death in a high proportion of patients.

show abstract

A Longitudinal Study of Lung Function in Nonsmoking Patients With Rheumatoid Arthritis

Cited by 32 publications

References 25 publications

Evaluation of lung function tests in rheumatoid arthritis patients

Evaluation of lung function tests in rheumatoid arthritis patients

Small airway obstruction in patients with rheumatoid arthritis

Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis

Contact Info

Product

Resources

About