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