Rheumatoid arthritis lung disease. Determinants of radiographic and physiologic abnormalities

Abstract

Objective. To determine the prevalence and important clinical predictors of radiographic and physiologic abnormalities indicative of rheumatoid arthritis interstitial lung disease (RA-ILD).Methods. An unselected cohort of patients with a confirmed diagnosis of RA and known lung disease were identified (n = 336) and evaluated for RA disease activity and seventy. Outcomes included abnormalities determined by the pulmonary function tests of forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLco), and/or chest radiographic findings of interstitial infiltrates. We used multivariable statistical modeling to determine the independent significance of cigarette smoking and other RA-specific factors on the pulmonary abnormalities of interest.Results. At least 1 of the 3 abnormal findings was identified by pulmonary tests in 32.4% of all patients. These abnormal findings included an FVC <80% of predicted in 42 patients, a DLco <80% of predicted in 64 patients, and evidence of radiographic interstitial infiltrates in 40 patients. After statistical adjustment for confounding factors, pack-years of cigarette smoking remained a significant predictor of low DLco (p = Submitted for publication January 22, 1996; accepted in revised form May 2, 1996. interstitial abnormalities on chest radiograph (odds ratio for 2 2 5 pack-years = 3.76,95% CI 1.59,8.88). The Health Assessment Questionnaire (HAQ) Disability Index (DI) was also an important risk factor for the decline in both the DLco ( p = -1.15, 95% CI -2.00, -0.30) and FVC ( p = -0.23, 95% CI -032, -0.13).-

Rheumatoid Arthritis-Associated Interstitial Lung Disease

“…The majority of cases of RA-ILD occur in patients between the ages of 50 and 60 years. While several studies 13,[15][16][17]20 have reported smoking, male gender, and longstanding RA to be risk factors for the development of ILD, other reports 13,14,16,17,19 have not shown any significant associations. In addition, genetic associations (human leukocyte antigen B40 and ␣ 1 -antitrypsin) have been described.…”

Low‐dose corticosteroids in rheumatoid arthritis. A meta‐analysis of their moderate‐term effectiveness

“…Low-dose corticosteroid use in RA is currently widespread, with up to 80% of patients in many arthritis practices using prednisone or similar corticosteroid preparations (1)(2)(3). Despite a relative paucity of published data, several authors have debated the value of corticosteroids for the treatment of RA (4)(5)(6)(7)(8).…”

Pleuropulmonary Pathology in Patients With Rheumatic Disease

“…Interestingly, cigarette smoking has been reported to be an independent predictor of lung disease in RA. 27 …”