| Rheumatoid arthritis is a chronic, progressive, | | | | identification and treatment may improve |
| systemic, autoimmune condition for which there is | | | | outcomes." |
| no known cure. It is a common disorder affecting | | | | The authors recruited 64 patients with |
| approximately 2.1 million Americans. | | | | rheumatoid arthritis without shortness of breath |
| While it is technically a form of arthritis, | | | | or cough and 10 with rheumatoid arthritis and |
| rheumatoid arthritis is a true systemic disease in | | | | pulmonary fibrosis (interstitial lung disease). |
| which multiple organ systems can be affected. | | | | High-resolution computed tomography identified |
| Among these are the skin with vasculitic ulcers, | | | | preclinical interstitial lung disease in 21 of the |
| eyes leading to scleritis or episcleritis | | | | asymptomatic patients (33%). |
| (inflammatory eye disease), glands that make | | | | Pulmonary function tests such as air flow and lung |
| saliva and tears leading to dryness of the eyes | | | | volumes which measure lung function were |
| and mouth, lymph nodes sometimes causing | | | | normal in the interstitial lung disease patients at |
| lymphoma, cardiovascular system leading to early | | | | baseline, but gas exchange (the ability to transfer |
| heart attack and stroke, and the lungs. | | | | oxygen into the lungs and get rid of carbon |
| Lung involvement can take multiple forms. | | | | dioxide out of the lungs) was impaired in patients |
| Rheumatoid arthritis can cause pleurisy | | | | with no interstitial lung disease. |
| (inflammation of the lining of the lungs), nodules | | | | During a mean follow-up of 2 years, repeat |
| within the lungs, pneumonia, inflammation of the | | | | scanning showed disease progression in 12 |
| small airways (bronchitis and bronchiolitis), and | | | | subjects with preclinical interstitial lung disease and |
| inflammation of the lung tissue. This latter | | | | in 6 subjects with pulmonary fibrosis; the rate of |
| condition is called interstitial lung disease. | | | | change was low and similar in the two groups. |
| Patients with rheumatoid arthritis are examined | | | | "In this cohort of patients with rheumatoid |
| clinically and sometimes interstitial lung disease is a | | | | arthritis, preclinical interstitial lung disease is |
| finding that is picked up on physical examination. | | | | prevalent and progressive," the authors stated. |
| Prior to starting drugs such as TNF inhibitors | | | | They also wrote: "The natural history of disease |
| (Enbrel, Humira, Remicade), a chest x-ray is also | | | | resembles that of pulmonary fibrosis, and high |
| obtained and sometimes interstitial lung disease is | | | | resolution computed tomography is more |
| found then. However, chest x-ray is not very | | | | sensitive than pulmonary function test |
| sensitive for picking up interstitial lung disease | | | | measurements in detecting early progression of |
| early. | | | | preclinical interstitial lung disease." |
| A recent study found some disturbing evidence | | | | Two thirds of patients with lung disease and less |
| that oftentimes patients with rheumatoid arthritis | | | | than one quarter without lung disease had a |
| may have subclinical interstitial lung disease. This | | | | history of smoking, and the mean number of |
| means that the lung disease is there without any | | | | pack-years smoked was significantly higher in the |
| symptoms. | | | | lung disease group. Therefore, the authors say, |
| The researchers found that "preclinical interstitial | | | | clinicians should recommend that patients with |
| lung disease detected by high-resolution computed | | | | rheumatoid arthritis should stop smoking. |
| tomography is prevalent and progressive in | | | | The scientists concluded: "High resolution |
| patients with rheumatoid arthritis." (Arch Intern | | | | computed tomography may be indicated to |
| Med 2008;168:159-166). High resolution | | | | identify early preclinical ILD in patients with RA |
| computerized tomography is a fine detail CAT | | | | whose physical examinations reveal crackles." |
| scan technique. | | | | Author's note: I agree with these findings and |
| The prevalence of asymptomatic interstitial lung | | | | always send patients for a CAT scan of the lungs |
| disease in rheumatoid arthritis is unknown. The | | | | if I detect crackles on physical examination. The |
| authors of the study said, though, that "given the | | | | presence of lung disease is also a prompt to |
| availability of new therapeutic options, early | | | | become more aggressive with treatment. |