Rheumatoid arthritis (RA) is
a chronic systemic disease of unknown etiology characterized by articular
involvement, extra-articular involvement, and the presence of serum rheumatoid
factor. Pulmonary involvement in RA is a common extra-articular manifestation of rheumatoid
arthritis (RA) that confers significant morbidity and mortality. We undertook
this study to determine the prevalence and spectrum of
pulmonary abnormalities in patients with rheumatoid arthritis (RA) from a North
Indian town. 62 patients who met the American College of Rheumatology (formerly the American
Rheumatism Association) 1987 classification criteria for RA were subjected to clinical examination of chest, X-Ray-chest (CXR),
pulmonary function tests (PFT) and high resonance computed tomography (HRCT).
40.3% patients had some pulmonary symptoms with exertional dyspnoea in21%,
cough with expectoration in 17.7%, fine respiratory rales in 11.3%,patients
X-ray chest bilateral lower zone haziness in 16% and prominent pulmonary
vasculature in 3.2%. 43% had abnormal PFT-restrictive pattern
in 29%, obstructive pattern 8% and mixed pattern in 6.4%. HRCT revealed
abnormal findings in 33.8% commonest being ground glass pattern in both lower
lobes 19.3%, sub pleural reticulations in 9.6%, pleural thickening in 3.2% and
pulmonary vascular prominence in 1.6%. To provide optimal treatment, physicians
must always consider the possibility of associated pulmonary manifestations
when patients with RA are evaluated.
References
[1]
K. Chanin, F. Vallejo-Manzur, G. L. Sternbach, et al., “Pulmonary Manifestations of Rheumatoid Arthritis,” Hospital Physician, 2001, pp. 23-28.
[2]
C. Turesson and L. T. Jacobsson, “Epidemiology of Extra-Articular Manifestations in Rheumatoid Arthritis,” Scandinavian Journal of Rheumatology, Vol. 33, No. 2, 2004, pp. 65-72. doi:10.1080/03009740310004621
[3]
C. Turesson, L. Jacobsson and U. Bergstrom, “Extra-Articular Rheumatoid Arthritis: Prevalence and Mortality,” Rheumatology (Oxford), Vol. 38, No. 7, 1999, pp. 668-674. doi:10.1093/rheumatology/38.7.668
[4]
B. R. Gochuico, N. A. Avila, C. K. Chow, L. J. Novero, H. P. Wu, P. Ren, S. D. MacDonald, W. D. Travis, M. P. Stylianou and I. O. Rosas, “Progressive Preclinical Interstitial Lung Disease in Rheumatoid Arthritis,” Archives of Internal Medicine, Vol. 168, No. 2, 2008, pp. 159-166.
doi:10.1001/archinternmed.2007.59
[5]
V. Saravanan and C. A. Kelly, “Reducing the Risk of Methotrexate Pneumonitis in Rheumatoid Arthritis,” Rheumatology (Oxford), Vol. 43, No. 2, 2004, pp. 143-147.
doi:10.1093/rheumatology/keg466
[6]
C. Kelly and V. Saravanan, “Treatment Strategies for a Rheumatoid Arthritis Patient with Interstitial Lung Disease,” Expert Opinion on Pharmacotherapy, Vol. 9, No. 18, 2008, pp. 3221-3230.
doi:10.1517/14656560802591430
[7]
F. C. Arnett, S. M. Edworthy, D. A. Bloch, D. J. McShane, J. F. Fries, N. S. Cooper, L. A. Healey, S. R. Kaplan, M. H. Liang, H. S. Luthra, T. A. Medsger and R. L. Hunder, “The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis,” Arthritis Rheum, Vol. 31, No. 3, 1988, pp. 315-324. doi:10.1002/art.1780310302
[8]
C. LeMaistre, “A Statement by the Committee on Standards for Epidemiology Surveys on Chronic Respiratory Disease of the American Thoracic Society,” National Tuberculosis and Respiratory Disease Association, New York, 1969, p. 32.
[9]
“Recommended Respiratory Disease Questionnaires for Use with Adults and Children in Epidemiological Research,” 1978, pp. 7-53.
http://www.thoracic.org/statements/resources/archive/rrdquacer.pdf
[10]
E. Akhtar, S. Bilal, et al., “Prevelence of Arthritis in India and Pakistan: A Review,” Rheumatology International, Vol. 31, No. 7, 2011, pp. 849-855.
doi:10.1007/s00296-011-1820-3
[11]
A. N. Malviya, S. K. Kapoor, et al., “Prevelence of Rheumatoid Arthritis in the Adult Indian Population,” Rheumatology International, Vol. 13, No. 4, 1993, pp. 13-14.
[12]
P. Milind and K. Sushila, “How to Live with Rheumatoid Arthritis,” International Research Journal of Pharmacy, Vol. 3, No. 3, 2012, pp. 115-121.
[13]
L. M. Pamell, C. L. Galligon and C. N. Fish, “Sex Affects Immunity Autoimmune,” 2012.
[14]
F. R Lake, “Interstitial Lung Disease in Rheumatoid Ar tritis,” 2012, pp. 1-4.
http://www.uptodate.com/contents/interstitial-lung-disease-in-rheumatoid-arthritis
[15]
R. L. Collin, R. A. Turner, A. M. Johnson, et al., “Obstructive Pulmonary Disease in Rheumatoid Arthritis,” Arthritis Rheum, Vol. 19, No. 3, 1976, pp. 623-628.
doi:10.1002/art.1780190316
[16]
E. Gabbay, R. Tarala, R. Will, et al., “Interstitial Lung Disease in Recent Onset Rheumatoid Arthritis,” American Journal of Respiratory and Critical Care Medicine, Vol. 156, No. 2, 1997, pp. 528-535.
doi:10.1164/ajrccm.156.2.9609016
[17]
J. K. Dawson, H. E. Fewins, J. Desmond, et al., “Fibrosing Alveolitis in Patient with Rheumatoid Arthritis as Assessed by High Resolution Computed Tomography, Chest Radiography and Pulmonary Function Tests,” Thorax, Vol. 56, No. 8, 2001, pp. 622-627.
doi:10.1136/thorax.56.8.622
[18]
E. J. Hall and D. J. Brenner, “Cancer Risks from Diagnostic Radiology,” British Journal of Radiology, Vol. 81, No. 965, 2008, pp. 362-378. doi:10.1259/bjr/01948454
[19]
J. W. Card, W. J. Racz, J. F. Brien, S. B. Margolin and T. E. Massey, “Differential Effects of Pirfenidone on Acute Pulmonary Injury and Ensuing Fibrosis in the Hamster Model of Amiodarone-Induced Pulmonary Toxicity,” Toxicological Sciences, Vol. 75, No. 1, 2003, pp. 169-180.
doi:10.1093/toxsci/kfg167
[20]
W. A. Gahl, M. Brantly, J. Troendle, N. A. Avila, A. Padua, C. Montalvo, H. Cardona, K. A. Calis and B. Gochuico, “Effect of Pirfenidone on the Pulmonary Fibrosis of Hermansky-Pudlaksyndrome,” Molecular Genetics and Metabolism, Vol. 76, No. 3, 2002, pp. 234-242.
doi:10.1016/S1096-7192(02)00044-6
