Rheumatoid arthritis-associated lung disease in black Africans: Descriptive study of 28 cases in Lomé

Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory disorder of unknown pathogenesis that most often affects the joints, resulting in progressive, symmetrical and erosive destruction of cartilage and bone. It is the most common connective tissue disease, [1] affecting ~1% of the white populations in North America and Europe. [2] The prevalence of RA in black Africans is considered low, but is difficult to quantify. [3,4] Although it appears primarily as a joint disease, RA is a systemic condition that can affect several organs, including the heart, lungs, kidneys, eyes, nerves and skin. One study revealed extra-articular manifestations of RA in a quarter of patients, [2] while another showed a cumulative incidence of 15 years in 53% of them. [2] Of these, lung disease is the common extra-articular manifestation of RA detected in 40-70 % of cases [2,5] and a major cause of morbidity and mortality in RA patients. [6] In some cases, respiratory symptoms may precede the development of joint symptoms or the diagnosis of RA. [7] This may involve all parts of the lung, including pleura, airways, parenchyma and vasculature. [8] These changes may reflect chronic immune activation, increased susceptibility to infection (often related to immunomodulatory medications) or direct toxicity due to diseasemodifying or biological therapy. [1,9] Few studies on RA-associated lung diseases have been conducted in black Africans, [10,11] while many have been conducted in North American and European white populations. [6,8,12] The objective of this study was to describe the lung manifestations in the RA population of Lomé, Togo. Methods Patients Patients meeting the American College of Rheumatology (ACR) criteria for RA [13] were included in this study, regardless of disease duration and the presence of pulmonary symptoms. They were selected from the outpatient pulmonology clinic of the Sylvanus Olympio University hospital of Lomé, and from rheumatology clinics in three central hospitals in Lomé (Sylvanus Olympio University hospital, regional hospital and district III hospital). They were collected over a period from October 2018 to July 2019, and informed oral consent was obtained from each participating patient. All patients underwent clinical assessment, spirometry test, a 6-minute walk test (6MWT) and a chest X-ray (CXR). Clinical assessment A full clinical evaluation of the chest was performed to look for any symptoms or signs suggesting lung disease. Other extra-articular symptoms or signs were also noted. Pulmonary function tests (PFTs) Spirometry was obtained with Spirolab MIR. It was performed in accordance with the guidelines of the American Thoracic Society and European Respiratory Society. [14] Vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/ FVC ratio with a threshold 70%, total lung capacity and maximum expiratory flow at 25% of vital capacity, 50% of vital capacity and 75%

Evaluating rheumatoid arthritis-associated pulmonary disease in Africa

“… [1] The paper in this issue by Gbadamassi et al . [2] from Lomé, Togo, suggests that over 70% of patients with rheumatoid arthritis had features suggestive of lung disease. In their group of 28 patients with RA, dyspnoea was present in 47%, with ILD demonstrated on chest radiograph in 18%.…”

Comorbidities and extra-articular manifestations of Rheumatoid arthritis in sub-Saharian Africa

“…It is responsible for primary damage to the joints leading to their inflammation and progressive destruction in the absence of let alone without rapid and adequate treatment [2]. Extra-articular manifestations are also frequent with a frequency that can reach 50% with the progression of the disease [3]. Rheumatoid arthritis impairs the quality of life due to its joint damage but is also associated with high mortality.…”