Respiratory involvement in rheumatoid arthritis physiologic abnormalities and determinants of radiographic
Loading...
Date
2002
Authors
Mohamed Ismail, Asmahan
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Pulmonary disease in rheumatoid arthritis (RA) may take many forms
including pleural lesions, lung nodules, interstitial pulmonary fibrosis, and
obliterative bronchiolitis. In 1947, Ellman first described diffuse bilateral
interstitial changes in the lungs of a patient with rheumatoid arthritis and
many similar cases have been reported throughout the world. In addition to
the distinct lung disorders mentioned above, low grade disease of the
respiratory tract, and even considerable impairment of respiratory function,
may occur in rheumatoid arthritis in spite of radiologically normal lungs. M.
Linstow and colleagues in 1994 have showed that patients suffering from
RA have prominent functional pulmonary abnormality.
The aim of this study is to evaluate prevalence and characteristic of
respiratory involvement in patients with rheumatoid arthritis. The
characteristic will be determined by doing a lung function test in all patient
confmned to have rheumatoid arthritis while evaluation of the radiographic
changes is done with a chest radiograph. The second objective is to assess
the relationship between disease activity and lung involvement.
The study was carried out during a period between November 2000 to
October 2001. The patients were recruited from Rheumatology Clinic and
medical wards, Hospital Universiti Sains Malaysia who fulfllled inclusion
and exclusion criteria. All patients should satisfy the American Rheumatic
Association criteria for Rheumatoid Arthritis. Once patients were identified,
a brief explanation of the study was made. Baseline investigations includes
full blood count, erythrocyte sedimentation rate, renal and liver function test.
The immunological system is evaluated by doing a rheumatoid factor,
complement level and C-reactive protein. Lung function test were
performed for all patients and highest reading was taken as the fmal result. A
chest radiograph was done on all patients included in this study. They were
also asked for associated respiratory symptoms of chronic cough, shortness
of breath and assessed of presence of basal crepitations clinically.
There were significant different in the mean FVC, FEVt and FEVt/FVC of
patients with RA as compared to normal population. The most common
types of respiratory function abnormality in patients with RA was restrictive
type where the FVC% was less than 80%.
Assessment of chest radiograph revealed twelve abnormalities in the chest xray
of RA patients and out of this , 50% of the lung function test is normal.
The most common abnormalities detected is peribronchial and/or pleural
thickening and interstitial lung disease.
While 84.6% of patients with normal chest x-ray had restrictive type of
abnormality on their lung function test. There were no relationship between
the sign and disease activity with lung function test. The physiological function of the respiratory system in rheumatoid arthritis
patients are abnormal eventhough they remain asymptomatic.
The most common abnormalities in rheumatoid lung disease by doing the
lung function test is the restrictive type. Lung function test predicts lung
abnormalities better than assessment of chest radiography. The lung function
is not affected by sign, chest radiographic fmding and activity of disease.
However there is suggestion that the longer the disease, the more likely to
have abnormal and more severe impairment of the lung function test.
Description
Keywords
Rheumatoid arthritis (RA)