Lung involvement in patients with rheumatoid arthritis: a cross-sectional study

Abstract

BackgroundRheumatoid arthritis (RA) is a chronic in ammatory condition primarily characterized by joint pain and swelling. However, it can also affect various organs, including the heart, nervous system, eyes, and lungs. Pulmonary involvement is a signi cant contributor to morbidity and mortality in RA patients, encompassing a spectrum of manifestations such as interstitial lung disease (ILD), bronchiectasis, pleural involvement, and more. ILD can progress to pulmonary brosis, impacting the overall prognosis of RA. MethodsIt is a prospective, analytical, and descriptive cross-sectional study conducted between September 2019 and September 2022 involving RA patients diagnosed according to the 2010 classi cation criteria of the American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR). Structured interviews collected demographic and clinical data, while laboratory tests, HRCT scans, and pulmonary function tests were performed. Disease activity was assessed using DAS-28 and SDAI. ResultsA total of 203 patients were included, predominantly female (88%), with a mean age of 57.14 years. Most patients were non-smokers (74.9%) and exhibited moderate disease activity (35% by DAS-28, 41.1% by SDAI). Nearly half of the sample had antibodies, with 47.5% positive for RF and 48.5% for Anti-CCP. HRCT revealed abnormalities in 89.6% of patients, with ILD present in 17% and pulmonary brosis in 6.5%. RF was associated with ILD and small airway involvement, while male gender correlated with emphysema and small airway involvement. ConclusionsPulmonary involvement, assessed via HRCT, was highly prevalent in RA patients, even those without respiratory symptoms. These ndings underscore the importance of early pulmonary evaluation during RA, as well as the need for monitoring and managing pulmonary manifestations, particularly in patients with speci c risk factors such as male gender, advanced age, and positive antibodies. BACKGROUNDRheumatoid arthritis (RA) is a chronic in ammatory disease characterized by joint pain and swelling. Despite the predominance of joint involvement, RA is a multisystem disease with an autoimmune background, which can affect several organs and systems, such as the heart, the nervous system, the eyes, and the lungs, among others(1, 2).Lung involvement is a signi cant cause of morbidity and mortality. Manifestations can be varied and sometimes do not result in signi cant symptoms. However, they can represent different conditions, from interstitial in ltrates, bronchiectasis, and bronchiolitis, pleural involvement, presence of rheumatoid nodules in the lungs, diseases of the vascular bed, pulmonary toxicity due to the medicinal effect of drugs used to treat the condition, and even secondary infectious processes(3).Interstitial lung disease (ILD) is the most prevalent manifestation, and some cases can progress to pulmonary brosis and, consequently, respiratory failure, affecting the prognosis with an autoimmune background, which can affect several organs and systems, such as...