Small Airway Disease in Rheumatoid Arthritis

Abstract

Variety of pulmonary lesions are thought to be associated with rheumatoid arthritis (RA). These lesions traditionally have included pleurisy with or without effusion, Caplan’s syndrome, pulmonary rheumatoid nodules, diffuse interstitial fibrosis, and pulmonary arteritis and hypertension. But little attention has been paid to the airways in RA. Recently, several repots have suggested an association between airflow limitation and RA, but its incidence is not known. Also whether there exists a parameter of disease activity of RA, suggesting the presence of small airway disease (SAD) is not clear.To answer these questions, the serologic parameters which reflect the disease activity of RA and pulmonary function tests which reflect small airway dysfunction were performed on 36 lifetime nonsmokers with RA who had normal chest x-ray findings. The prevalence of SAD and the relationships between the disease activity parameters of RA and pulmonary function were observed.The results were as follows. The percentages of patients with abnormal values for diffusing capacity, frequency dependence of compliance (C1.0/C0.0), forced expiratory flow25–75%, Vmax50% and Vmax75% were 45.5%, 62.5%, 40%, 22.8% and 11.4%, respectively. There was statistically significant negative correlation between C1.0/C0.0 and ESR. But consistent correlation between other pulmonary function tests and clinical and serologic parameters of RA, and differences in pulmonary function between patients who were serologically positive and negative for CRP and FANA, were not found.In conclusion, SAD, without the influence of smoking, is frequently associated with RA, but, the presence of SAD cannot be predicted from any clinical and seologic parameters of RA currently in use.

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

“…Whereas in some cases, the predominant defect was volume restriction with impaired gas transfer, 18,20,26,29 in others airway obstruction, both large and small, predominated. 4,17,21,23,24 In the studies 6,25,30,31 with HRCT, bronchiectasis was sometimes the most common lesion.…”

“…There have been a considerable number of crosssectional studies looking at the prevalence of pulmo-nary abnormalities in patients with RA who were not known to have lung involvement. The older studies 4,5,[17][18][19][20][21][22][23][24] used PFTs to detect the abnormalities, whereas in more recent times this has been combined with HRCT of the thorax 6,7,[25][26][27][28] ; all studies concur in that a high prevalence of abnormality (35 to 65%) can be found. By contrast, 27% of our population had pulmonary function abnormalities that may represent patterns of disease in both 1990 and 2000.…”

“…Clearly, the diagnostic modality used (radiology or physiology) will have a large impact on the range of lesions detected. Few studies selected a cohort of nonsmoking patients, 22,24,28,32 and in all cases a proportion of the subjects had preexisting respiratory symptoms. All patients had RA, but some studies applied further inclusion criteria such as disease activity or DMARD use.…”

Pulmonary Vasculitis and Rheumatic Diseases

“…Small airway disease has been described in RA patients, but there is no clear association with vasculitis or disease activity markers. 17 Fibrosing alveolitis and OP are manifestations of RA lung disease. 18,19 Pleuritis and pericarditis are seen in patients with RA and vasculitis, 414 but pleural involvement may be independent of vasculitis.…”

Design of a Self-Measuring Device Based on Bioelectrical Impedance Analysis for Regular Monitoring of Rheumatoid Arthritis

“…A study comparing joint damage in patients with RA who received early treatment and those who received delayed treatment showed that the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels tended to be significantly lower in patients who underwent early treatment. In other words, early treatment significantly reduces disease activity and joint damage in patients with RA and lowers inflammation at the beginning of the disease, resulting in good treatment effects [11]. Patients with suspected Sensors 2024, 24, 2526 2 of 21 RA are recommended to seek help within six weeks of symptom onset and undergo early management directed by a rheumatologist [12][13][14].…”