INFO - Lung involvement in patients with RA

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s Hopkins Arthritis Center

by Dimitrios Pappas, MD

Lung Involvement in Patients with Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic inflammatory disease that leads to

chronic pain, high rates of disability and unemployment (1-8).

Furthermore, the lifespan of RA patients is shortened by approximately

10 years (1-7), and standardized mortality ratios for RA range from

1.28 to 3.0 (2).

Respiratory causes, are a significant contributor to excess mortality

in patients with RA ranking as the second major cause of death in this

patient population (9). While the treatment of rheumatoid articular

disease has greatly improved in recent years, as measured by disease

activity and quality of life instruments, these benefits have not

extended to RA-associated lung disease.

A number of pulmonary manifestations are associated with RA. The most

common is interstitial lung disease (ILD) which leads to pulmonary

fibrosis (PF) during which the lung parenchyma is involved (10).

Interstitial lung disease (ILD) is not only the most common but also

the most serious form of lung involvement in RA. Radiographic changes

such as fibrosis, and physiological changes such as restriction or

decreased diffusing capacity on pulmonary function testing, may

precede symptoms by years; however, once clinically apparent, ILD is

associated with significant mortality (11). The reported prevalence of

subclinical and symptomatic (clinically evident) ILD in RA varies

depending on the method of detection and ranges between 1 and 58%

(12-16).

Recently, attention has been drawn to the higher prevalence of Chronic

Obstructive Pulmonary Disease (COPD) in patients with RA. COPD has

been reported to occur more frequently in patients with RA than in the

general population even after adjusting for smoking, and is believed

to have a more pronounced impact on survival compared to COPD in

patients without RA (17).

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http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/rheum-lung.\

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