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Connective Tissue Disease

  • Ray E. Stanford

Abstract

It has been recognized for over a century that patients with “rheumatism” may have respiratory abnormalities as well. However, only in the last 20 years or so, as tests of pulmonary function have become increasingly sophisticated and more widely available, has it become clear that pleuropulmonary manifestations in the various connective tissue disorders are in fact quite common.1,2 Involvement of the lungs has been described in nearly every variety of connective tissue disease (CTD), from the hereditary syndromes of Marfan and Ehlers-Danlos3,4,5 through the immunologically mediated collagen vascular diseases (CVD) to the related systematic vasculitis, granulomatosis, and lymphoproliferative disorders.

Keywords

Systemic Lupus Erythematosus Interstitial Lung Disease Connective Tissue Disease Interstitial Pneumonitis Obliterative Bronchiolitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Rhodes ML, Smith JD. The lung in autoimmune collagen vascular disease. Heart Lung 1977; 6: 653–659.PubMedGoogle Scholar
  2. 2.
    Hunninghake GW, Fauci AS. Pulmonary involvement in the collagen vascular diseases. Am Rev Respir Dis 1979; 119: 471–503.PubMedGoogle Scholar
  3. 3.
    Lipton RA, Greenwald RA, Serif NS. Pneumothorax and bilateral honeycombed lung in Marfan syndrome. Am Rev Respir Dis 1971; 104: 924–928.PubMedGoogle Scholar
  4. 4.
    Cupo LN, Pyeritz RE, Olson JL, McPhee SJ, Hutchins GM, McKusick VA. Ehlers-Danlos syndrome with abnormal collagen fibrils, sinus of Valsalva aneurysms, myocardial infarction, panacinar emphysema and cerebral heterotopias. Am J Med 1981; 71: 1051–1058.PubMedCrossRefGoogle Scholar
  5. 5.
    Wood JR, Bellamy D, Child AH, Citron KM. Pulmonary disease in patients with Marfan syndrome. Thorax 1984; 39: 780–784.PubMedCrossRefGoogle Scholar
  6. 6.
    Boulware DW, Weissman DN, Doll NJ. Pulmonary manifestations of the rheumatic diseases. Clin Rev Allergy 1985; 3: 249–267.PubMedCrossRefGoogle Scholar
  7. 7.
    Eisenberg H. The interstitial lung diseases associated with the collagen-vascular disorders. Clin Chest Med 1982; 3: 565–578.PubMedGoogle Scholar
  8. 8.
    Stanford RE. Rheumatoid and other collagen lung diseases. Semin Respir Med 1982; 4: 107–112.CrossRefGoogle Scholar
  9. 9.
    Dreisin RB. Lung diseases associated with immune complexes. Am Rev Respir Dis 1981; 124: 748–752.Google Scholar
  10. 10.
    Janossy G, Duke O, Poulter LW, Panagi G, Bofill M, Goldstein G. Rheumatoid arthritis: a disease of T-lymphocyte/macrophage immunoregulation. Lancet 1981; 2: 839–842.PubMedCrossRefGoogle Scholar
  11. 11.
    Geddes DM, Brewerton DA, Webley M, et al. Alpha-1antitrypsin phenotypes in fibrosing alveolitis and rheumatoid arthritis. Lancet 1977; 1: 1049–1051.CrossRefGoogle Scholar
  12. 12.
    Cooney TP. Interrelationship of chronic eosinophilic pneumonia, bronchiolitis obliterans, and rheumatoid disease: a hypothesis. J Clin Pathol 1981; 34: 129–137.PubMedCrossRefGoogle Scholar
  13. 13.
    Dreisin RB, Schwarz MI, Theofilopoulos AN, Stanford RE. Circulating immune complexes in the idiopathic interstitial pneumonias. N Engl J Med 1978; 298: 353–357.PubMedCrossRefGoogle Scholar
  14. 14.
    Hammar SP, Winterbauer RH, Bockus D, Remington F, Sale GE, Meyers JD. Endothelial cell damage and tubuloreticular structures in interstitial lung disease associated with collagen vascular disease and viral pneumonia. Am Rev Respir Dis 1983; 127: 77–84.PubMedGoogle Scholar
  15. 15.
    Churg A, Franklin W, Chan KL, Kopp E, Carrington CB. Pulmonary hemmorhage and immune complex deposition in the lung: complications in a patient with systemic lupus erythematosus. Arch Pathol Lab Med 1980; 104: 388–391.PubMedGoogle Scholar
  16. 16.
    Leatherman JW, Sibley RK, Davies SF. Diffuse intrapulmonary hemorrhage and glomerulonephritis unrelated to anti-glomerular basement membrane antibody. Am J Med 1982; 72: 401–410.PubMedCrossRefGoogle Scholar
  17. 17.
    Leatherman JW, Davies SF, Hoidal JR. Alveolar hemorrhage syndromes: diffuse microvascular lung hemorrhage in immune and idiopathic disorders. Medicine (Baltimore) 1984; 63: 343–361.Google Scholar
  18. 18.
    Myers JL, Katzenstein AA. Microangiitis in lupus-induced pulmonary hemorrhage. Am J Clin Pathol 1986; 85: 552–556.PubMedGoogle Scholar
  19. 19.
    Chandler DB, Fulmer JD. Pulmonary vasculitis. Lung 1985; 163: 257–273.PubMedCrossRefGoogle Scholar
  20. 20.
    Fulmer JD, Kaltreider HB. The pulmonary vasculitides. Chest 1982; 82: 615–624.PubMedCrossRefGoogle Scholar
  21. 21.
    Dreisin RB. Pulmonary vasculitis. Clin Chest Med 1982; 3: 607–618.PubMedGoogle Scholar
  22. 22.
    Wiener-Kronish JP, Solinger AM, Warnock ML, Churg A, Ordonez N, Golden JA. Severe pulmonary involvement in mixed connective tissue disease. Am Rev Respir Dis 1981; 124: 499–503.PubMedGoogle Scholar
  23. 23.
    Massumi RA, Legier JF. Rheumatic pneumonitis. Circulation 1966; 33: 417–425.PubMedCrossRefGoogle Scholar
  24. 24.
    Andrews BS, Arora NS, Shadforth MF, Goldberg SK, Davis JS IV. The role of immune complexes in the pathogenesis of pleural effusions. Am Rev Respir Dis 1981; 124: 115–120.PubMedGoogle Scholar
  25. 25.
    Halla JT, Schrohenloher RE, Volanakis JE. Immune complexes and other laboratory features of pleural effusions. Ann Intern Med 1980; 92: 748–752.PubMedCrossRefGoogle Scholar
  26. 26.
    Rosenow EC III, Strimlan CV, Muhm JR, Ferguson RH. Pleuropulmonary manifestations of ankylosing spondylitis. Mayo Clin Proc 1977; 52: 641–649.PubMedGoogle Scholar
  27. 27.
    Stroh! KP, Feldman NT, Ingram RH Jr. Apical fibrobullous disease with rheumatoid arthritis. Chest 1979; 75: 739–741.CrossRefGoogle Scholar
  28. 28.
    Landensuo A, Mittila J, Vilppula A. Bronchiolitis in rheumatoid arthritis. Chest 1984; 85: 705–708.CrossRefGoogle Scholar
  29. 29.
    McCann BG, Hart GJ, Stokes TC, Harrison BDW. Obliterative bronchiolitis and upper-zone pulmonary consolidation in rheumatoid arthritis. Thorax 1983; 38: 73–74.PubMedCrossRefGoogle Scholar
  30. 30.
    Begin R, Massé S, Cantin A, Ménard H-A, Bureau M-A. Airway disease in a subset of nonsmoking rheumatoid patients: characterization of the disease and evidence for an autoimmune pathogenesis. Am J Med 1982; 72: 743–750.PubMedCrossRefGoogle Scholar
  31. 31.
    Anonymous. Obliterative bronchiolitis (editorial), Lancet 1982; 1: 603–604.Google Scholar
  32. 32.
    Kinney WW, Angelillo VA. Bronchiolitis in systemic lupus erythematosus. Chest 1982; 82: 646–649.PubMedCrossRefGoogle Scholar
  33. 33.
    Schwarz MI, Matthay RA, Sahn SA, Stanford RE, Marmorstein BL, Scheinhorn DJ. Interstitial lung disease in polymyositis and dermatomyositis: analysis of six cases and review of the literature. Medicine (Baltimore) 1976; 55: 89–104.CrossRefGoogle Scholar
  34. 34.
    Jansen HM. Local immunopathologic findings in bronchiolitis associated with collagen vascular diseases. Chest 1985; 87: 136.PubMedCrossRefGoogle Scholar
  35. 35.
    Michet CJ, McKenna CH, Luthra HS, O’Fallon WM. Relapsing polychondritis: survival and predictive role of early disease manifestations. Ann Intern Med 1986; 104: 74–78.PubMedCrossRefGoogle Scholar
  36. 36.
    Nomura S, Kumagai N, Kanoh T, Uchino H, Kurihara J. Pulmonary amyloidosis associated with systemic lupus erythematosus. Arthritis Rheum 1986; 29: 680–682.PubMedCrossRefGoogle Scholar
  37. 37.
    Batra P, Collins JD, Magidson JG. Pulmonary nodular amyloidosis presenting as Sjögren’s syndrome. J Natl Med Assoc 1983; 75: 903–905.PubMedGoogle Scholar
  38. 38.
    Edelson JD, Hyland RH, Ramsden M, et al. Lung inflammation in scleroderma: clinical, radiographic, physiologic and cytopathological features. J Rheumatol 1985; 12: 957963.Google Scholar
  39. 39.
    Jansen HM, Schutte AJ, van der Giessen M, The TH. Immunoglobulin classes in local immune complexes recovered by bronchoalveolar lavage in collagen vascular diseases. Lung 1984; 162: 287–296.PubMedCrossRefGoogle Scholar
  40. 40.
    Silver RM, Metcalf JF, Stanley JH, LeRoy C. Interstitial lung disease in scleroderma: analysis by bronchoalveolar lavage. Arthritis Rheum 1984; 27: 1254–1262.PubMedCrossRefGoogle Scholar
  41. 41.
    Jansen HM, Schutte AJ, Elema JD, et al. Local immune complexes and inflammatory response in patients with chronic interstitial pulmonary disorders associated with collagen vascular diseases. Clin Exp Immunol 1984; 56: 311–320.PubMedGoogle Scholar
  42. 42.
    Rossi GA, Bitterman PB, Rennard SI, Ferrans VJ, Crystal RG. Evidence for chronic inflammation as a component of the interstitial lung disease associated with progressive systemic sclerosis. Am Rev Respir Dis 1985; 131: 612–617.PubMedGoogle Scholar
  43. 43.
    Peters-Golden M, Wise RA, Hochberg M, Stevens MB, Wigley FM. Incidence of lung cancer in systemic sclerosis. J Rheumatol 1985; 12: 1136–1139.PubMedGoogle Scholar
  44. 44.
    Medsger TA Jr. Systemic sclerosis and malignancy: Are they related? (editorial) J Rheumatol 1985; 12: 1041 1043.Google Scholar
  45. 45.
    Roumm AD, Medsger TA Jr. Cancer and systemic sclerosis: an epidemiologic study. Arthritis Rheum 1985; 28: 1336–1340.PubMedCrossRefGoogle Scholar
  46. 46.
    Shenberger KN, Schned AR, Taylor TH. Rheumatoid disease and bronchogenic carcinoma: case report and review of the literature. J Rheumatol 1984; 11: 226–228.PubMedGoogle Scholar
  47. 47.
    Ahern MJ, Maddison P, Mann S, Scott CA Ankylosing spondylitis and adenocarcinoma of the lung. Ann Rheum Dis 1982; 41: 292–294.PubMedCrossRefGoogle Scholar
  48. 48.
    McCormick J, Cole S, Lahirir B, Knauft K, Cohen S, Yoshida T. Pneumonitis caused by gold salt therapy: evidence for the role of cell-mediated immunity in its pathogenesis. Am Rev Respir Dis 1980; 122: 145–152.PubMedGoogle Scholar
  49. 49.
    Murphy KC, Atkins CJ, Offer RC, Hogg JC, Stein HB. Obliterative bronchiolitis in two rheumatoid arthritis patients treated with penicillamine. Arthritis Rheum 1981; 24: 557–560.PubMedCrossRefGoogle Scholar
  50. 50.
    St Clair EW, Rice JR, Snyderman R. Pneumonitis complicating low-dose methotrexate therapy in rheumatoid arthritis. Arch Intern Med 1985; 145: 2035–2038.CrossRefGoogle Scholar
  51. 51.
    Anonymous. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 3–1982. An elderly woman with mild rheumatoid arthritisGoogle Scholar
  52. and progressive pulmonary fibrosis. N Engl J Med 1982; 306: 157–165.CrossRefGoogle Scholar
  53. 52.
    Krane SM, Simon LS. Rheumatoid arthritis: clinical features and pathogenetic mechanisms. Med Clin North Am 70. 1986; 70: 263–284.Google Scholar
  54. 53.
    Lovell D, Lindsley C, Langston C. Lymphoid interstitial pneumonia in juvenile rheumatoid arthritis. J Pediatr 71. 1984; 105: 947–950.CrossRefGoogle Scholar
  55. 54.
    Corbett AJ, Zizic TM, Stevens MB. Adult-onset Still’s disease with an associated severe restrictive pulmonary 72. defect: a case report. Ann Rheum Dis 1983; 42: 452–454.PubMedCrossRefGoogle Scholar
  56. 55.
    Baydur A, Mongan ES, Slager UT. Acute respiratory failure and pulmonary arteritis without parenchymal in 73. volvement: demonstration in a patient with rheumatoid arthritis. Chest 1979; 75: 518–520.PubMedCrossRefGoogle Scholar
  57. 56.
    Macfarlane JD, Franken CK, van Leeuwen AW. Progressive cavitating pulmonary changes in rheumatoid ar 74. thritis: a case report. Ann Rheum Dis 1984; 43: 98–101.PubMedCrossRefGoogle Scholar
  58. 57.
    Petrie JP, Caughey DE. Bilateral apical fibrobullous disease complicated by bilateral Aspergillus mycetomata in rheumatoid arthritis. NZ Med J 1983; 96: 7–8.Google Scholar
  59. 58.
    Petrie GR, Bloomfield P, Grant IW, Crompton GK. Up- 75. per lobe fibrosis and cavitation in rheumatoid disease. Br J Dis Chest 1980; 74: 263–267.PubMedCrossRefGoogle Scholar
  60. 59.
    Herzog CA, Miller RR, Hoidal JR. Bronchiolitis and rheu- 76. matoid arthritis. Am Rev Respir Dis 1981; 124: 636–639.PubMedGoogle Scholar
  61. 60.
    Geddes DM, Corrin B, Brewerton DA, Davies RJ, Turner- 77. Warwick M. Progressive airway obliteration in adults and its association with rheumatoid arthritis. Q J Med 1977; 46: 427–444.PubMedGoogle Scholar
  62. 61.
    Segal AM, Calabrese LH, Ahmad M, Tubbs RR, White 78. CS. The pulmonary manifestations of systemic lupus erythematosus. Semin Arthritis Rheum 1985; 14: 202–224.PubMedCrossRefGoogle Scholar
  63. 62.
    Pines A, Kaplinsky N, Olchovsky D, Rozenman J, Frankl O. Pleuro-pulmonary manifestations of systemic lupus 80. erythematosus: clinical features of its subgroups. Prognostic and therapeutic implications. Chest 1985; 88: 129135. 81.Google Scholar
  64. 63.
    Miller LR, Greenberg SD, McLarty JW. Lupus lung. Chest 1985; 88: 265–269.Google Scholar
  65. 64.
    Desnoyers MR, Bernstein S, Cooper AG, Kopelman RI. 82. Pulmonary hemorrhage in lupus erythematosus without evidence of an immunologic cause. Arch Intern Med 1984; 144: 1398–1400. 83.Google Scholar
  66. 65.
    Richerson HB. Immune complexes and the lung: a skeptical review. Sury Synth Pathol Res 1984; 3: 281–291.Google Scholar
  67. 66.
    Matthay RA, Schwarz MI, Petty TL, et al. Pulmonary 84. manifestations of systemic lupus erythematosus: review of twelve cases of acute lupus pneumonitis. Medicine (Baltimore) 1974; 54: 397–409. 85.Google Scholar
  68. 67.
    Miller RW, Salcedo JR, Fink RJ, Murphy TM, Magilavy DB. Pulmonary hemorrhage in pediatric patients with systemic lupus erythematosus. J Pediatr 1986; 108: 576–86. 579.Google Scholar
  69. 68.
    Domingo-Pedrol P, Rodriguez-de la Serna A, ManceboCortes J, Sanchez-Segura JM. Adult respiratory distress syndrome caused by acute systemic lupus erythematosus. 87. Eur J Respir Dis 1985; 67: 141–144.PubMedGoogle Scholar
  70. 69.
    Lyon MG, Bewtra C, Kenik JG, Hurley JA. Tubuloreticu lar inclusions in systemic lupus pneumonitis. Report of a case and review of the literature. Arch Pathol Lab Med 1984; 108: 599–600.PubMedGoogle Scholar
  71. 70.
    Eisenberg H, Dubois EL, Sherwin RP, Balchum OJ. Diffuse interstitial lung disease in systemic lupus erythematosus. Ann Intern Med 1973; 79: 37–45.PubMedCrossRefGoogle Scholar
  72. 71.
    Haupt HM, Moore GW, Hutchins GM: The lung in systemic lupus erythematosus: analysis of the pathologic changes in 120 patients. Am J Med 1981; 71: 791–798.PubMedCrossRefGoogle Scholar
  73. 72.
    Bettman MA, Kantrowitz F. Rapid onset of lung involvement in progressive systemic sclerosis. Chest 1979; 75: 509–510.CrossRefGoogle Scholar
  74. 73.
    Silver RM, Metcalf JF, LeRoy EC. Interstitial lung disease in scleroderma. Immune complexes in sera and bronchoalveolar lavage fluid. Arthritis Rheum 1986; 29: 525–531.PubMedCrossRefGoogle Scholar
  75. 74.
    Furst DE, Clements PJ, Saab M, Sterz MG, Paulus HE. Clinical and serological comparison of 17 chronic progressive systemic sclerosis (PSS) and 17 CREST syndrome patients matched for sex, age, and disease duration. Ann Rheum Dis 1984; 43: 794–801.PubMedCrossRefGoogle Scholar
  76. 75.
    Anonymous. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case number 43–1979. N Engl J Med 1979; 301: 929–936.CrossRefGoogle Scholar
  77. 76.
    Tan EM, Steigerwald JC. Personal communication, February 1982.Google Scholar
  78. 77.
    Salmeron G, Greenberg SD, Lidsky MD. Polymyositis and diffuse interstitial lung disease: a review of the pulmonary histopathologic findings. Arch Intern Med 1981; 141: 1005–1010.PubMedCrossRefGoogle Scholar
  79. 78.
    Dickey BF, Myers AR. Pulmonary disease in polymyositis/ dermatomyositis. Semin Arthritis Rheum 1984; 14: 60–76.PubMedCrossRefGoogle Scholar
  80. 79.
    Park SJ, Nyhan WL. Fatal pulmonary involvement in dermatomyositis. Am J Dis Child 1975; 129: 723–726.PubMedGoogle Scholar
  81. 80.
    Fergusson RJ, Davidson NM, Nuki G, Crompton GK. Dermatomyositis and rapidly progressive fibrosing alveolitis. Thorax 1983; 38: 71–72.PubMedCrossRefGoogle Scholar
  82. 81.
    Vitali C, Tavoni A, Simi U, Vieji G, Bombardieri S. A plasma cell granuloma in a patient with Sjögren’s syndrome. J Rheumatol 1985; 12: 1212–1214.PubMedGoogle Scholar
  83. 82.
    Fairfax AJ, Haslam PL, Pavia D, et al. Pulmonary disorders associated with Sjögren’s syndrome. Q J Med 1981; 50: 279–295.PubMedGoogle Scholar
  84. 83.
    Strimlan CV, Rosenow EC III, Divertie MB, Harrison EG Jr. Pulmonary manifestations of Sjögren’s syndrome. Chest 1976; 70: 354–361.PubMedCrossRefGoogle Scholar
  85. 84.
    Prakash UB, Luthra HS, Divertie MB. Intrathoracic manifestations in mixed connective tissue disease. Mayo Clin Proc 1985; 60: 813–821.PubMedCrossRefGoogle Scholar
  86. 85.
    Germain MJ, Davidman M. Pulmonary hemorrhage and acute renal failure in a patient with mixed connective tissue disease. Am J Kidney Dis 1984; 3: 420–424.PubMedGoogle Scholar
  87. 86.
    Rumancik WM, Firooznia H, Davis MS Jr, et al. Fibrobullous disease of the upper lobes: an extraskeletal manifestation of ankylosing spondylitis. J Comput Tomogr 1984; 8: 225–229.PubMedCrossRefGoogle Scholar
  88. 87.
    Cohen AA, Natelson EA, Fechner RE. Fibrosing interstitial pneumonitis in ankylosing spondylitis. Chest 1971; 59: 369–371.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 1988

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  • Ray E. Stanford

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