Lung diseases directly associated with rheumatoid arthritis and their relationship to outcome

Abstract

The outcome and cause of death of each lung disease directly associated with rheumatoid arthritis (RA-LD) have been poorly investigated.A retrospective study was conducted of 144 patients with RA-LD, in whom the median follow-up period after the initial visit for a respiratory examination was 4.5 yrs.A total of 57 patients were identified with usual interstitial pneumonia (UIP), 31 with bronchiectasis, 16 with nonspecific interstitial pneumonia (NSIP), 11 with bronchiolitis, five with organising pneumonia (OP), five with diffuse alveolar damage (DAD) and 19 with combined disease. The 5-yr survival rates were 36.6% in the UIP group, 87.1% in the bronchiectasis group, 93.8% in the NSIP group, 88.9% in the bronchiolitis group, 60.0% in the OP group and 20.0% in the DAD group. Survival of patients with DAD was worse than that of patients with UIP. Overall, survival of patients with UIP was worse than that of patients with bronchiectasis, NSIP or bronchiolitis. Of the 144 patients, 71 (49.3%) died, of whom 58 (81.7%) died due to respiratory lesions.Of patients with RA-LD, patients with DAD experienced the highest mortality, and the survival of patients with UIP was worse than that of patients with NSIP.

Small airways diseases, excluding asthma and COPD: an overview

“…Chronic respiratory failure (as defined by the need of long-term oxygen therapy) occurred in 40% of patients, including four patients who died of respiratory failure [55]. In another series that evaluated 144 patients with rheumatoid arthritis and respiratory manifestations, 5-year survival rates were 36% in 57 patients with usual interstitial pneumonia, 87% in 31 patients with bronchiectasis, 94% in 16 patients with NSIP and 89% in 11 patients with bronchiolitis [83]. It is concluded that bronchiolitis is associated with poor prognosis essentially in patients with severe airflow limitation and marked hyperinflation, and that these features mostly occurred in patients with obliterative (rather than follicular) bronchiolitis.…”

Rheumatoid arthritis-associated lung disease

“…This may not be unique to the UIP pattern, as significantly higher numbers of CD4 + T-cells have been described in tissue samples from both UIP and NSIP when compared to purely idiopathic interstitial pneumonia [36]. Distinguishing among patterns of ILD can be useful in prognostication as patients with UIP or DAD have greater 5-year mortality compared to those with patterns such as NSIP or organising pneumonia [37]. …”

Chronic inflammation and lung fibrosis: pleotropic syndromes but limited distinct phenotypes

“…Limited data suggest that a history of smoking is more common among RA patients whose lung biopsy specimens display UIP as opposed to NSIP or other patterns. 41,42 Reasons for this predilection among smokers are unclear. Cigarette smoke extract depletes intracellular glutathione, increases lipid peroxidation, and induces necrosis in human alveolar epithelial cells in a dosedependent manner, 43 suggesting that oxidative stress is a significant trigger for type I pneumocyte loss and alveolar disintegrity.…”