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