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Respiratory symptoms in rheumatoid arthritis: relation to pulmonary abnormalities detected by high-resolution CT and pulmonary functional testing

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Abstract

Pulmonary disease is the most frequent and among the most severe extra-articular manifestation of rheumatoid arthritis (RA). However, this issue has not been sufficiently studied in Egyptian patients. The objectives of the present study are to investigate the prevalence and types of pulmonary involvement using high-resolution computed tomography scan (HRCT) and pulmonary function tests (PFT) and evaluate the association between respiratory symptoms and RA-lung disease in a group of Egyptian RA patients. Thirty-six RA patients were recruited; 34 females (94.4%) and 2 males (5.6%) with median age of 48.5 years, and none of them was smoker. Detailed medical and drug histories were obtained. PFT, plain X-ray of the chest, and HRCT were performed to all subjects involved. Nearly 64% of RA patients demonstrated abnormalities in PFT and 47% in HRCT. Mixed restrictive and obstructive pattern was the commonest. Nearly two-thirds of our patients reported one or more pulmonary symptom whether dyspnea, cough, wheezing, or phlegm. Dyspnea was the most frequent symptom. Respiratory symptoms were statistically more common in patients with lung disease. The advanced age, high radiological score, and severity of rheumatoid disease were found to be predictive of lung involvement. Among respiratory symptoms, dyspnea and cough were associated with any pulmonary abnormalities. When specific pulmonary abnormalities were considered, only dyspnea was identified as predictor for restriction. For obstructive abnormality, both cough and wheezing provided valid prediction. We conclude that pulmonary involvement is a common manifestation in Egyptian RA patients, and the pattern of involvement is generally consistent with other studies that were performed worldwide. Specific respiratory symptoms could be used as practical, easy, and cost-effective method, especially in older and with more severe RA patients, to discriminate patients in need of subsequent PFT and HRCT imaging.

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References

  1. Kelly WN (2005) Management of rheumatoid arthritis. In: Kelley WN, Harris ED, Ruddy S, Sledge CB (eds) Textbook of rheumatology, 3rd edn. WB Saunders, Philadelphia

    Google Scholar 

  2. Turesson C, Jacobsson L, Crowson CS (2003) Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis 62:722–727

    Article  PubMed  CAS  Google Scholar 

  3. Lioté H (2008) Pulmonary manifestation of rheumatoid arthritis. Rev Mal Respir 25(8):973–988

    Article  PubMed  Google Scholar 

  4. Young A, Koduri G, Batley M, Kulinskaya E, Gough A, Norton S, Dixey J, Early Rheumatoid Arthritis Study (ERAS) group (2007) Mortality in rheumatoid arthritis. increased in the early course of disease, in ischaemic heart disease and in pulmonary fibrosis. Rheumatology (Oxford) 46:350–357

    Article  CAS  Google Scholar 

  5. Cortet B, Perez T, Roux N, Flipo RM, Duquesnoy B, Delcambre B, Rémy-Jardin M (1997) Pulmonary function tests and high resolution computed tomography of the lungs in patients with rheumatoid arthritis. Ann Rheum Dis 56(10):596–600

    Article  PubMed  CAS  Google Scholar 

  6. Turesson C, O’Fallon WM, Crowson CS (2002) Occurrence of extra-articular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis. J Rheumatol 29:62–67

    PubMed  Google Scholar 

  7. Tanaka N, Kim JS, Newell JD, Brown KK, Cool CD, Meehan R, Emoto T, Matsumoto T, Lynch DA (2004) Rheumatoid arthritis-related lung diseases: CT findings. Radiology 232(1):81–91

    Article  PubMed  Google Scholar 

  8. Fuld JP, Johnson MK, Cotton MM, Carter R, Watkin SW, Capell HA, Stevenson RD (2003) A longitudinal study of lung function in nonsmoking patients with rheumatoid arthritis. Chest 124:1224–1231

    Article  PubMed  Google Scholar 

  9. Drent M, du Bois R (2003) Recent advances in the diagnosis and management of nonspecific interstitial pneumonia. Curr Opin Pulm Med 9:411–417

    Article  PubMed  Google Scholar 

  10. Dong Soon K (2005) Interstitial lung disease in rheumatoid arthritis: recent advances. Pulm Med 12:346–353

    Google Scholar 

  11. Dawson JK, Fewins HE, Desmond J (2001) Fibrosing alveolitis in patients with rheumatoid arthritis as assessed by high resolution computed tomography, chest radiography and pulmonary function tests. Thorax 56:622–627

    Article  PubMed  CAS  Google Scholar 

  12. Pappas DA, Giles JT, Connors G, Lechtzin N, Bathon JM, Danoff SK (2010) Respiratory symptoms and disease characteristics as predictors of pulmonary function abnormalities in patients with rheumatoid arthritis: an observational cohort study. Arthritis Res Ther 12(3):R104

    Article  PubMed  Google Scholar 

  13. Gabbay E, Tarala R, Will R, Carroll G, Adler B, Cameron D, Lake FR (1997) Interstitial lung disease in recent onset rheumatoid arthritis. Am J Respir Crit Care Med 156:528–535

    PubMed  CAS  Google Scholar 

  14. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  PubMed  CAS  Google Scholar 

  15. Lung Tissue Research Consortium consent form. http://www.ltrcpublic.com/LTRC_Ann_09.pdf

  16. Recommended respiratory disease questionnaires for use with adults and children in epidemiological research. [http://www.thoracic.org/sections/publications/statements/pages/archive/rrdquacer.htm]

  17. Huskisson EC (1974) Measurement of pain. Lancet 2(7889):1127–1131

    Article  PubMed  CAS  Google Scholar 

  18. Prevoo ML, van ‘t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38(1):44–48

    Article  PubMed  CAS  Google Scholar 

  19. Fransen J, Creemers M, Van Riel P (2004) Remission in rheumatoid arthritis: agreement of the disease activity score (DAS28) with the ARA preliminary remission criteria. Rheumatology 43(10):1252–1255

    Article  PubMed  CAS  Google Scholar 

  20. Walker DJ, Griffiths M, Dewar P, Coates E, Dick WC, Thompson M, Griffiths ID (1985) Association of MHC antigens with susceptibility to and severity of rheumatoid arthritis in multicase families. Ann Rheum Dis 44(8):519–525

    Article  PubMed  CAS  Google Scholar 

  21. Bruce B, Fries JF (2003) The Stanford Health Assessment Questionnaire: dimensions and practical applications. Health Qual Life Outcomes 1:20

    Article  PubMed  Google Scholar 

  22. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CP, Gustafsson P, Hankinson J, Jensen R, Johnson DC, MacIntyre N, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J (2005) Interpretative strategies for lung function tests. Eur Respir J 26:948–968

    Article  PubMed  CAS  Google Scholar 

  23. Bilgici A, Ulusoy H, Kuru O, Celenk C, Unsal M, Danaci M (2005) Pulmonary involvement in rheumatoid arthritis. Rheumatol Int 25(6):429–435

    Article  PubMed  Google Scholar 

  24. van der Heijde D (2000) How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol 27(1):261–263

    PubMed  Google Scholar 

  25. Schurawitzki H, Stiglbauer R, Graninger W, Herold C, Pölzleitner D, Burghuber OC, Tscholakoff D (1990) Interstitial lung disease in progressive systemic sclerosis: high-resolution CT versus radiography. Radiology 176(3):755–759

    PubMed  CAS  Google Scholar 

  26. Brusselle G (2010) Rheumatoid arthritis and interstitial lung disease. A dangerous liaison. Rheumatology 49:1425–1426

    Article  PubMed  Google Scholar 

  27. Young A, Koduri G, Batley M, Kulinskaya K, Gough A, Dixey J (2007) Mortality in rheumatoid arthritis. Increased in the early course of disease, in ischaemic heart disease and pulmonary fibrosis. Rheumatology 46:350–357

    Article  PubMed  CAS  Google Scholar 

  28. Zrour SH, Touzi M, Bejia I, Golli M, Rouatbi N, Sakly N, Younes M, Tabka Z, Bergaoui N (2005) Correlations between high-resolution computed tomography of the chest and clinical function in patients with rheumatoid arthritis. Prospective study in 75 patients. Joint Bone Spine 72(1):41–47

    Article  PubMed  Google Scholar 

  29. Karazincir S, Akoğlu S, Güler H, Balci A, Babayiğit C, Eğilmez E (2009) The evaluation of early pulmonary involvement with high resolution computerized tomography in asymptomatic and non-smoker patients with rheumatoid arthritis. Tuberk Toraks 57(1):14–21

    PubMed  Google Scholar 

  30. Kanat F, Levendoglu F, Teke T (2007) Radiological and functional assessment of pulmonary involvement in the rheumatoid arthritis patients. Rheumatol Int 27(5):459–466

    Article  PubMed  Google Scholar 

  31. Saag KG, Kolluri S, Koehnke RK, Georgou TA, Rachow JW, Hunninghake GW, Schwartz DA (1996) Rheumatoid arthritis lung disease. Determinant of radiographic and physiologic abnormalities. Arthritis Rheum 39:1711–1719

    Article  PubMed  CAS  Google Scholar 

  32. Terasaki H, Fujimoto K, Hayabuchi N, Ogoh Y, Fukuda T, Müller NL (2004) Respiratory symptoms in rheumatoid arthritis: relation between high resolution CT findings and functional impairment. Radiat Med 22(3):179–185

    PubMed  Google Scholar 

  33. McDonagh GM, Wright AR, Heycock C, Owen JP, Kelly C (1994) High resolution computed tomography of the lungs in patients with rheumatoid arthritis and interstitial lung disease. Br J Rheumatol 33:118–122

    Article  PubMed  CAS  Google Scholar 

  34. Koduri G, Norton S, Young A, Cox N, Davies P, Devlin J, Dixey J, Gough A, Prouse P, Winfield J, Williams P, On behalf of ERAS (Early Rheumatoid Arthritis Study) (2010) Interstitial lung disease has a poor prognosis in rheumatoid arthritis: results from an inception cohort. Rheumatology 49:1483–1489

    Article  PubMed  Google Scholar 

  35. Shidara K, Hoshi D, Inoue E, Yamada T, Nakajima A, Taniguchi A, Hara M, Momohara S, Kamatani N, Yamanaka H (2010) Incidence of and risk factors for interstitial pneumonia in patients with rheumatoid arthritis in a large Japanese observational cohort, IORRA. Mod Rheumatol 20:280–286

    Article  PubMed  Google Scholar 

  36. Vergnenègre A, Pugnère N, Antonini MT, Arnaud M, Melloni B, Treves R, Bonnaud F (1997) Airway obstruction and rheumatoid arthritis. Eur Respir J 10:1072–1078

    Article  PubMed  Google Scholar 

  37. Jobanputra P, Maggs F, Homer D, Bevan J (2002) Monitoring and assessing the safety of disease-modifying antirheumatic drugs: a West Midlands experience. Drug Saf 25(15):1099–1105

    Article  PubMed  CAS  Google Scholar 

  38. Dawson JK, Graham DR, Desmond J, Fewins HE, Lynch MP (2002) Investigation of the chronic pulmonary effects of low-dose oral methotrexate in patients with rheumatoid arthritis: a prospective study incorporating HRCT scanning and pulmonary function tests. Rheumatology (Oxford) 41:262–267

    Article  CAS  Google Scholar 

  39. Khadadah ME, Jayakrishnan B, Gorair SA, Mutairi MA, Maradni NA, Onadeko B (2002) Malaviya an effect of methotrexate on pulmonary function in patients with rheumatoid arthritis—a prospective study. Rheumatol Int 22:204–207

    Article  PubMed  CAS  Google Scholar 

  40. Suissa S, Hudson M, Ernst P (2006) Leflunomide use and the risk of interstitial lung disease in rheumatoid arthritis. Arthritis Rheum 54(5):1435–1439

    Article  PubMed  CAS  Google Scholar 

  41. Sawada T, Inokuma S, Sato T, Otsuka T, Saeki Y, Takeuchi T, Matsuda T, Takemura T, Sagawa A (2009) Study Committee for Leflunomide-induced Lung Injury, Japan College of Rheumatology. Leflunomide-induced interstitial lung disease: prevalence and risk factors in Japanese patients with rheumatoid arthritis. Rheumatology (Oxford) 48(9):1069–1072

    Article  CAS  Google Scholar 

  42. Dedhia HV, DiBartolomeo A (2002) Rheumatoid arthritis. Crit Care Clin 18:841–854

    Article  PubMed  Google Scholar 

  43. Perez T, Remy-Jardin M, Cortet B (1998) Airways involvement in rheumatoid arthritis. Clinical, functional, and HRCT findings. Am J Respir Crit Care Med 157:1658–1665

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Rheumatology and Rehabilitation Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Amir A. Youssef & Shereen A. Machaly

  2. Chest Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Mohammed E. El-Dosoky

  3. Rheumatology and Rehabilitation Department, Talkha Central Hospital, Talkha, Egypt

    Nermeen M. El-Maghraby

Authors
  1. Amir A. Youssef
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  2. Shereen A. Machaly
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  3. Mohammed E. El-Dosoky
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  4. Nermeen M. El-Maghraby
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Correspondence to Shereen A. Machaly.

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Youssef, A.A., Machaly, S.A., El-Dosoky, M.E. et al. Respiratory symptoms in rheumatoid arthritis: relation to pulmonary abnormalities detected by high-resolution CT and pulmonary functional testing. Rheumatol Int 32, 1985–1995 (2012). https://doi.org/10.1007/s00296-011-1905-z

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  • DOI: https://doi.org/10.1007/s00296-011-1905-z

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