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