Small airway obstruction in patients with rheumatoid arthritis

Abstract

This work was intended to evaluate the prevalence of obstructive small-airway disease in patients with rheumatoid arthritis (RA) and its association with clinical characteristics. Pulmonary function testing (PFT) and high-resolution computed tomography (HRCT) were performed on 189 consecutive RA patients. Each case was diagnosed based on abnormal HRCT findings. We defined obstructive dysfunction of small airways as a forced expiratory flow from 25% to 75% of vital capacity (FEF25–75) value >1.96 residual standard deviation (RSD) below predicted values. We found 19 patients (10.1%) with an interstitial pneumonia (IP) pattern and 15 (7.9%) with a bronchiolitis pattern; the other 155 (82.0%) had no abnormal HRCT patterns. In patients with neither abnormal pattern, median values of percentage predicted for carbon monoxide diffusing capacity (DLCO) and ratio of DLCO to alveolar ventilation (DLco/VA) were within the normal range, but median FEF25–75, forced expiratory flow at 25% of vital capacity (V25), and V25/height were <70% of predicted values. Forty-seven patients (30.3%) in this group had obstructive small-airway dysfunction. Multivariate logistic regression analysis indicated that this type of abnormality is strongly associated with respiratory symptoms [odds ratio (OR) 5.18; 95% confidence interval (CI) 1.70–15.75; p = 0.012), smoking history (OR 2.78; 95% CI 1.10–6.99; p = 0.03), and disease duration >10 years (OR 2.86; 95% CI 1.27–6.48; p = 0.012). Parenchymal micronodules, bronchial-wall thickening, and bronchial dilatation on HRCT scans were also predictive factors for abnormal FEF25–75, although these morphological changes were too limited for us to diagnose these patients with the bronchiolitis pattern. Obstructive dysfunction of small airways is apparently common among RA patients, even among those with neither the IP nor the bronchiolitis pattern on HRCT scans. Factors significantly associated with abnormal FEF25–75 are respiratory symptoms, smoking history, and RA duration.

Radiological features and therapeutic responses of pulmonary nontuberculous mycobacterial disease in rheumatoid arthritis patients receiving biological agents: a retrospective multicenter study in Japan

“…Middleton et al [12] have reported that, unlike M. tuberculosis, M. avium complex tends to adhere to damaged respiratory mucosa through a fibronectin-mediated process. Recently, we have shown that bronchiolar abnormalities are commonly seen in RA patients, especially those with long-standing RA [13, 14]. In addition, bronchiectasis was the most frequent finding in both patients with early RA and those with long-standing RA [14].…”

Anti-inflammatory, antioxidant, and immunomodulatory aspects of Nigella sativa for its preventive and bronchodilatory effects on obstructive respiratory diseases: A review of basic and clinical evidence

“…A common pathologic mechanism such as circulating immune complexes and complement deposition has been suggested for these multiple organ manifestations of inflammatory process (Mori, Koga, & Sugimoto, 2011). Regarding the role of drug side effect in these diseases, it is necessary to find a multipotential safe medication.…”

Interstitial Pneumonia With Autoimmune Features: Overview of Proposed Criteria and Recent Cohort Characterization

“…Unexplained pleural or pericardial effusion or thickening on HRCT has been shown to occur more frequently with CTD-ILD than idiopathic interstitial pneumonia. 25 Concomitant airway disease is often present in patients with connective tissue diseases, particularly rheumatoid arthritis 26 , and features such as a disproportionately reduced FEV1 or elevated residual volume on PFTs, mosaic attenuation or bronchiectasis on HRCT or follicular or constrictive bronchiolitis on SLB could be used to make this determination. 19 Pre-capillary pulmonary hypertension is a prevalent clinical manifestation in CTDs, particularly scleroderma 27 , and is defined as a mean pulmonary artery pressure of over 25 mm Hg in the setting of a pulmonary arterial wedge pressure of less than 15 mm.…”