Pulmonary involvement in rheumatoid arthritis

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Pulmonary involvement in rheumatoid arthritis

Semin Arthritis Rheum 24: 242-254 (1995)[PMID7740304,MUID95258785]

Pulmonary involvement in rheumatoid arthritis.

J. M. Anaya, L. Diethelm, L. A. Ortiz, M. Gutierrez, G. Citera, R. A. Welsh

&

L. R. Espinoza

Department of Medicine, Louisiana State University School of Medicine, New

Orleans, USA.

Pulmonary involvement is one of the extra-articular manifestations of

rheumatoid arthritis (RA) and includes pleurisy, parenchymal nodules,

interstitial involvement, and airway disease.

Rheumatoid pulmonary vasculitis is rare.

Pulmonary disease also may be observed as a toxic event consequent to

treatment

for RA. Although RA is more common in women, rheumatoid lung disease occurs

more frequently in men who have long-standing rheumatoid disease, positive

rheumatoid factor and subcutaneous nodules.

Pleural involvement, usually asymptomatic, is the most common manifestation

of

lung disease in RA and may occur concurrently with pulmonary nodulosis or

interstitial disease. The clinical features and course of pulmonary fibrosis

in

RA are similar to those of idiopathic pulmonary fibrosis. Bronchiolitis

obliterans organizing pneumonia (BOOP), which has been recently described in

RA

patients, has nonspecific clinical features.

The histological patterns correspond to proliferative bronchiolitis in the

airway and organizing pneumonia in the alveoli.

Obstructive lung disease in RA includes obliterative bronchiolitis (OB) and

bronchiectasis. OB is an acute illness characterized histologically by a

constrictive bronchiolitis. It may be idiopathic or induced by

D-penicillamine

or intramuscular gold compounds.

Methotrexate (MTX)-pneumonitis is an uncommon complication of MTX treatment.

Its clinical presentation is not specific, and diagnosis must be made after

exclusion of other causes of pulmonary diseases. It is uncertain if

preexisting

lung disease predisposes RA patients to MTX-pneumonitis. Treatment of lung

disease in RA is empirical.

Corticosteroids are usually administered and immunosuppressive drugs are

often

added when pulmonary disease progresses and/or steroid side-effects appear.