Airways disease in rheumatoid arthritis patients

Abstract

Airflow limitation is a frequent finding in patients with rheumatic diseases. We have previously suggested that it is associated with autoimmune exocrinopathy in Sjögren's syndrome. To compare clinical features of patients with and without airways dysfunction and to further test the hypothesis of a link between airways disease and exocrinopathy, we prospectively studied 2 groups of 15 lifetime nonsmoker female patients with seropositive rheumatoid arthritis (RA). The 2 groups were similar in their clinical and immunologic features, but differed in terms of airways function. Salivary, lacrimal, and sweat gland dysfunction were significantly more prevalent or severe in the group with airways disease. Antinuclear antibodies were also more prominent in the patients with airways disease, but antibodies against RNP, SS‐A, SS‐B, and double‐stranded DNA were not present in these patients. HLA‐DR4 was found in 80% of the RA patients with airways disease and in 57% of those without airways disease. HLA–B8 and DR3 were equivalently distributed in both groups. This prospective study further documents the existence of small airways disease in RA and supports the view that autoimmune exocrinopathy predisposes to its expression.

Airway obstruction and rheumatoid arthritis

“…They have been attributed to a variety of factors including: underlying bronchial hyperreactivity [13]; abnormalities in distal bronchioles [22]; association with a deficit in alpha 1 -antitrypsin [8]; recurrent respiratory infections [6]; or treatment with penicillamine, which may favour bronchiolitis [7]. Certain authors have failed to find any link between the obstructive syndrome and Sjögren's syndrome [5], whereas others have found more severe disorders in patients with Sjögren' s syndrome [26,28].…”

“…Bronchiectasis and an increased incidence of chest infections have also been reported [3,4], but the pathophysiology is largely unknown. Although abnormal airway function has been described in 30-40% of RA patients depending on the study [5][6][7][8][9][10][11], the existence of a specific airway obstruction is a subject of debate [12].…”

“…Among the case-control studies, some have compared pulmonary function between RA patients and controls with degenerative joint disease [5,8,13], although, in most of the studies, RA patients have been compared with controls in the general population [6,7,10,11].…”

High resolution computed tomography of the lungs in patients with rheumatoid arthritis

“…However, the advance of high resolution computed tomography (HRCT) oers the possibility of a non invasive assessment of interstitial lung disease [6]. Using HRCT, bronchiectasis seems to be one of the most frequent manifestations, particularly in patients complaining of respiratory symptoms; according to the authors [7,8] its frequency ranges from 20% to 30%. The aim of this prospective study was to assess pulmonary involvement with HRCT in clinically asymptomatic and lifelong non-smoking patients with RA.…”

Collagen Vascular Diseases of the Lung

“…Small airways disease is also fairly common. 25,36,37,39,40 Patients with small airways disease will most commonly present with dyspnea on exertion and a nonproductive cough. Other less common symptoms can include wheezing and chest discomfort.…”