REVIEW - Pulmonary manifestations of RA

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Rev Mal Respir. 2008 Oct;25(8):973-88.

[Pulmonary manifestation of rheumatoid arthritis.][Article in French]

Lioté H.

Service de Pneumologie et réanimation respiratoire, Hôpital Tenon,

APHP, Paris, France.

Introduction Lung disease is the most frequent and among the most

severe extra-articular manifestation of rheumatoid arthritis (RA).

Several interesting advances have been made in recent years in our

understanding of this respiratory disease. State of art 1. The

induction of BALT responsible for follicular lymphoid infiltrates has

been demonstrated in the wall of respiratory bronchioles. These

lymphoid infiltrates are similar to synovial and skin cellular

infiltrates and secrete specific markers of RA (citrullinated

proteins). These data strongly suggest a common pathogenic mechanism

for RA in the joints and in other sites, such as the lung. 2.

Improvements in high resolution computed tomography (HR- CT) increased

the sensitivity of diagnosis. CT evidence of pulmonary disease is

present in 50% of RA patients, but only 10% of these patients have

clinical symptoms. The different lung manifestations, frequently

combined, have been clearly described: pulmonary nodules (20%); small

airways disease (30%): bronchiolitis, bronchiolectasis, and

bronchiectasis; diffuse interstitial pneumonia of various types (20%).

3. Predictors of progression and therapeutic response remain unknown.

Therefore treatment is empirical and based on usual indications and on

drugs used in idiopathic fibrosis and other connective tissue

pulmonary pathologies. Conclusions New biological drugs such as TNF

blocking agents or anti CD20 antibody could be beneficial. Infections

and drug-induced pneumonitis are not described in this review but must

be considered systematically when an RA patient presents with lung

involvement.

PMID: 18971804

http://www.ncbi.nlm.nih.gov/pubmed/18971804

Not an MD