Obstructive pulmonary disease in rheumatoid arthritis

Abstract

Twenty-six of 43 patients (60.5%) with classic rheumatoid arthritis ( R A ) participating in a controlled, prospective study were found to have maximal midexpiratory flow rates (MMEFs) suggestive of obstructive pulmonary disease. Cigarette smokers with RA had significantly lower MMEFs than either nonsmokers with RA or smokers with degenerative joint disease. There was an increased prevalence of the Pi phenotype M S among the RA patients. Interstitial fibrosis, tobacco smoking, and protease inhibitor deficiencies were all significant factors in producing airway obstruction in patients with RA.A variety of respiratory tract lesions are thought to be associated with rheumatoid arthritis (RA) and are generally called "pleuropulmonary manifestations"

Airways disease in rheumatoid arthritis patients

“…We previously suggested that there was a temporal relationship between arthritic and respiratory involvement in RA patients with severe obstructive airways disease (5). The present findings fail to confirm this impression.…”

“…In a previous report, we suggested that deterioration of pulmonary function may proceed more rapidly in these patients than in cigarette smokers with chronic obstructive respiratory disease (5). Lung biopsies in our RA patients with small airways involvement revealed a peribronchiolar mononuclear cell infiltrate; this indicated that the small peripheral airways were the site of obstruction that had been detected on lung function tests.…”

“…Previous investigators have stressed the role of nonrheumatoid risk factors, such as pulmonary infections (25), alantitrypsin deficiency (26), penicillamine treatment (27), environmental pollution (28), and most important, smoking (29). We have favored the view that, as in primary SS, RA patients could have a lymphocytic infiltration of the bronchial mucosa as part of a generalized exocrinopathy (5,9). Histologic observations in RA patients with bronchiolitis obliterans support this view (2,5,7,8,30).…”

“…Lung volumes, flowvolume curves, and carbon monoxide diffusing capacities (DLco) were measured according to standard methods, as previously applied in our laboratory (5). Functional residual capacity was determined by the helium rebreathing method, and after initial equilibration, vital capacities were obtained at least 3 times to measure all lung volumes.…”

“…However, the histopathologic lesions of the small airways in our RA patients were found to be similar to those in patients with primary or secondary Sjogren's syndrome (SS) ( 6 4 , and our initial group of RA patients exhibited sicca features. This led us to suggest a possible generalized exocrine dysfunction as the basis of the airways disease (5,9). To further explore this hypothesis, we prospectively compared 2 groups of lifetime nonsmokers who had RA: 1 group (n = 15) with small airways disease documented by pulmonary function testing, and 1 group (n = 15) without airways disease.…”