Prevalence of Pulmonary Disorders in Patients with Newly Diagnosed Rheumatoid Arthritis

Cigarette smoking has been associated with several diffuse lung diseases in which both bronchiolar and interstitial lung inflammation appear to result from chronic tobacco smoke inhalation. These diseases occur primarily in relatively young adult smokers and include desquamative interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease, and pulmonary Langerhans cell histiocytosis. Although these diseases are associated with characteristic histopathologic and radiological features, there is significant overlap among these diseases, and some smokers may exhibit features indicative of the broad spectrum of smoking-related interstitial and bronchiolar lung injury patterns. Cigarette smoking has also been associated with acute eosinophilic pneumonia, and it increases the risk of developing other fibrotic interstitial lung diseases such as idiopathic pulmonary fibrosis and rheumatoid arthritis-associated interstitial lung disease. Although relatively uncommon, these smoking-related diffuse lung diseases should be recognized by clinicians as an important subset in the spectrum of interstitial lung diseases in which smoking cessation forms a central part of disease management. With the exception of acute eosinophilic pneumonia, which responds well to corticosteroid therapy, the role of corticosteroid and other immune-suppressive treatments in the management of smoking-related interstitial lung diseases is not entirely clear and is probably of limited utility, particularly in the absence of smoking cessation.

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“…Cigarette smoking also increases the risk of interstitial lung disease in patients with rheumatoid arthritis. 52…”

Section: Relationship Of Tobacco Smoke To Other Diffuse Lung Diseasesmentioning

confidence: 99%

Tobacco Smoke–Related Diffuse Lung Diseases

Vassallo

Ryu

2008

Semin Respir Crit Care Med

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“…Lung disease is a relatively common extraarticular manifestation of rheumatoid arthritis (RA), which can present with a restrictive and/or obstructive pattern, and is often clinically underrecognized . Significant restrictive lung disease, most commonly interstitial lung disease (ILD), occurs in 8–15% of patients with RA . Clinical symptoms are variable (most commonly dyspnea and cough), with the illness causing rapid deterioration in some patients while others remain relatively stable .…”

mentioning

confidence: 99%

Progressive Decline of Lung Function in Rheumatoid Arthritis–Associated Interstitial Lung Disease

Zamora-Legoff

Krause

Crowson

et al. 2017

Arthritis & Rheumatology

171

111

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Objective Interstitial lung disease (ILD) is associated with substantial morbidity in rheumatoid arthritis (RA), but very little is known about its long-term progression. Methods All patients with RA-ILD seen at Mayo Clinic in 1998-2014 with at least 4 weeks follow-up and at least 1 pulmonary function test (PFT) were identified and manually screened for study inclusion. Progression was defined as a diffusing capacity for carbon monoxide (DLCO) <40% predicted or too ill to perform, or a forced vital capacity (FVC) <50% predicted. Time to progression was analyzed using Kaplan-Meier methods. Results Of 167 included patients, 81 (49%) were female with mean age of 67 years (standard deviation: 10) at ILD diagnosis. Median follow-up time from ILD diagnosis was 3.3 (range: 0.01-14.8) years. A third of patients required supplemental oxygen, 40% developed DLCO <40% predicted and 22% developed FVC <50% predicted by 5 years after ILD diagnosis. Risk factors for DLCO progression were usual interstitial pneumonia (UIP) vs. nonspecific interstitial pneumonia (NSIP) (hazard ratio [HR]: 3.29; 95% confidence interval [CI]: 1.28, 8.41). Lower percent predicted DLCO and FVC at baseline increased the risk for progression to DLCO <40% and FVC<50% predicted, and higher rates of change in the first 6 months also increased the risk of progression. Conclusion Progressive loss of pulmonary function is common in RA-ILD and worse in patients with UIP than NSIP. Predictors of progression in patients with RA-ILD may aid clinicians in identifying patients at highest risk for progression of ILD.

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“…In addition, there are indications from an open label trial with blinded x-ray reading that tocilizumab also inhibits progression of joint damage (5).…”

Section: Division Of Rheumatology Department Of Internal Medicine IImentioning

confidence: 99%

ABSTRACTS – Symposium

2008

Int J of Rheum Dis

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Prevalence of Pulmonary Disorders in Patients with Newly Diagnosed Rheumatoid Arthritis

Cited by 28 publications

References 44 publications

Tobacco Smoke–Related Diffuse Lung Diseases

Tobacco Smoke–Related Diffuse Lung Diseases

Progressive Decline of Lung Function in Rheumatoid Arthritis–Associated Interstitial Lung Disease

ABSTRACTS – Symposium

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