PULMONARY MANIFESTATIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS VISITING TERTIARY CARE HOSPITAL
AbstractBackground: Rheumatoid arthritis is a common problem in elderly individuals. It is reported that lung involvement in these patients is widely present. This study was done with the purpose to assess the burden and characteristics of lung involvement in rheumatoid arthritis patients attending rheumatology clinic. Methods: This descriptive cross-sectional study, in which data was retrospectively collected, was carried out from April 2019 to December 2020 at the Rheumatology Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All adult rheumatoid arthritis individuals, irrespective of gender or duration of disease, were consecutively enrolled. Information regarding the baseline characteristics, medication history for rheumatoid arthritis, findings of immunological tests along with the frequency of lung involvement and its pattern were observed. Results: Of 254 patients, the mean age was 37.46 ±12.39 years. Females were predominantly higher as compared to males, i.e., 232 (91.3%) vs. 22 (8.7%) respectively. Current smoking status was found positive in 7 (2.8%) patients. The mean disease duration was 4.41 ±3.96 years. Furthermore, frequency of pulmonary manifestation was observed in 45 (17.7%) patients. A significantly higher mean difference of age (p-value <0.001) and disease duration (p-value <0.001) was observed among patients with and without pulmonary manifestation. Moreover, a significant association of current smoker was also observed with pulmonary manifestation. Conclusion: A considerable number of patients with rheumatoid arthritis had pulmonary manifestation. Furthermore, a significant relationship was observed with age, duration of disease, and current smokers.
Lin YJ, Anzaghe M, Schülke S. Update on the pathomechanism, diagnosis, and treatment options for rheumatoid arthritis. Cells 2020;9(4):880.
Littlejohn EA, Monrad SU. Early diagnosis and treatment of rheumatoid arthritis. Prim Care 2018;45(2):237–55.
Alunno A, Gerli R, Giacomelli R, Carubbi F. Clinical, epidemiological, and histopathological features of respiratory involvement in rheumatoid arthritis. Biomed Res Int 2017;2017:7915340.
Esposito AJ, Chu SG, Madan R, Doyle TJ, Dellaripa PF. Thoracic manifestations of rheumatoid arthritis. Clin Chest Med 2019;40(3):545–60.
Raimundo K, Solomon JJ, Olson AL, Kong AM, Cole AL, Fischer A, et al. Rheumatoid arthritis–interstitial lung disease in the United States: prevalence, incidence, and healthcare costs and mortality. J Rheumatol 2019;46(4):360–9.
Habib HM, Eisa AA, Arafat WR, Marie MA. Pulmonary involvement in early rheumatoid arthritis patients. Clin Rheumatol 2011;30(2):217–21.
Dahani A, Arain SR, Riaz A, Khan F, Jabeen R. Prevalence and Pattern of Pulmonary Manifestation in Patients with Connective Tissue Disorder. Cureus 2020;12(4):e7618.
Duarte AC, Porter JC, Leandro MJ. The lung in a cohort of rheumatoid arthritis patients—an overview of different types of involvement and treatment. Rheumatol 2019;58(11):2031–8.
Terasaki H, Fujimoto K, Hayabuchi N, Ogoh Y, Fukuda T, Müller NL. Respiratory symptoms in rheumatoid arthritis: relation between high resolution CT findings and functional impairment. Radiat Med 2004;22(3):179–85.
Klareskog L, Stolt P, Lundberg K, Källberg H, Bengtsson C, Grunewald J, et al. A new model for an etiology of rheumatoid arthritis: smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 2006;54(1):38–46.
Hedström AK, Stawiarz L, Klareskog L, Alfredsson L. Smoking and susceptibility to rheumatoid arthritis in a Swedish population-based case–control study. Eur J Epidemiol 2018;33(4):415–23.
Duarte AC, Sousa S, Cordeiro A, Santos MJ, da Silva JC. FRI0138 Lung involvement in rheumatoid arthritis–a portuguese reality. Ann Rheum Dis 2017;76:533.
Shaw M, Collins BF, Ho LA, Raghu G. Rheumatoid arthritis-associated lung disease. Eur Respir Rev 2015;24:1–16.
Zamora-Legoff JA, Krause ML, Crowson CS, Ryu JH, Matteson EL. Patterns of interstitial lung disease and mortality in rheumatoid arthritis. Rheumatology (Oxford) 2017;56:344–50.
Luukkainen R, Saltyshev M, Pakkasela R, Nordqvist E, Huhtala H, Hakala M. Relationship of rheumatoid factor to lung diffusion capacity in smoking and non-smoking patients with rheumatoid arthritis. Scand J Rheumatol 1995;24(2):119–20.
Tuomi T, Heliövaara M, Palosuo T, Aho K. Smoking, lung function, and rheumatoid factors. Ann Rheum Dis 1990;49(10):753–6.
Hill JA, Southwood S, Sette A, Jevnikar AM, Bell DA, Cairns E. Cutting edge: the conversion of arginine to citrulline allows for a high-affinity peptide interaction with the rheumatoid arthritis-associated HLA-DRB1*0401 MHC class II molecule. J Immunol 2003;171(2):538–41.
Cavagna L, Monti S, Grosso V, Boffini N, Scorletti E, Crepaldi G, et al. The multifaceted aspects of interstitial lung disease in rheumatoid arthritis. BioMed Res Int 2013;2013:759760.
Gochuico BR, Avila NA, Chow CK, Novero LJ, Wu HP, Ren P, et al. Progressive preclinical interstitial lung disease in rheumatoid arthritis. Arch Int Med 2008;168(2):159–66.
Juge PA, Lee JS, Lau J, Kawano-Dourado L, Serrano JR, Sebastiani M, et al. Methotrexate and rheumatoid arthritis associated interstitial lung disease. Eur Resp J 2021;57(2):2000337.
Conway R, Low C, Coughlan RJ, O'Donnell MJ, Carey JJ. Methotrexate and lung disease in rheumatoid arthritis: a meta‐analysis of randomized controlled trials. Arthritis Rheum 2014;66(4):803–12.
Rojas-Serrano J, Herrera-Bringas D, Pérez-Román DI, Pérez-Dorame R, Mateos-Toledo H, Mejía M. Rheumatoid arthritis-related interstitial lung disease (RA-ILD): methotrexate and the severity of lung disease are associated to prognosis. Clin Rheumatol 2017;36(7):1493–500.
Kiely P, Busby AD, Nikiphorou E, Sullivan K, Walsh DA, Creamer P, et al. Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts. BMJ Open 2019;9(5):e028466
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