Abstract
Lung disease is common in patients with rheumatoid arthritis (RA). The onset of lung involvement in RA is not well known. The objective is to describe the features and evolution of lung involvement in early RA, its relationship with disease activity parameters, smoking and treatments. Consecutive patients with early RA without respiratory symptoms were included and tracked for 5 years. Lung assessment included clinical, radiological and pulmonary function tests at diagnosis and during follow-up. Peripheral blood parameters (erythrocyte sedimentation rate, C reactive protein, rheumatoid factor and anti-citrullinated peptide autoantibodies) and scales of articular involvement, such as DAS28-CRP, were evaluated. 40 patients were included and 32 completed the 5-year follow up. 13 patients presented lung involvement in the initial 5 years after RA diagnosis, 3 of them interstitial lung disease. Significant decrease of diffusion lung transfer capacity of carbon monoxide over time was observed in six patients, 2 of them developed interstitial lung disease. DLCO decrease was correlated with higher values of CRP and ESR at diagnosis. Methotrexate was not associated with DLCO deterioration or lung disease development. Subclinical progressive lung disease correlates with RA activity parameters. Smoking status and methotrexate were not associated with development or progression of lung disease.
Highlights
Lung disease is common in patients with rheumatoid arthritis (RA)
Two patients presented interstitial lung disease (ILD) with preserved forced vital capacity (FVC) at the initial lung evaluation: one non-specific interstitial pneumonia (NSIP) and one organizing pneumonia (OP)
FVC and diffusing lung capacity for carbon monoxide (DLCO) correlations are shown in Tables 4 and 5 respectively. In this single-center prospective cohort study of patients with early RA, we demonstrate that the systematic lung evaluation, including high-resolution computed tomography (HRCT) and DLCO, allows the identification of respiratory abnormalities in more than onethird of cases, most of them without symptoms
Summary
Lung disease is common in patients with rheumatoid arthritis (RA). The onset of lung involvement in RA is not well known. The onset of lung impairment and its association with rheumatic disease or potential drug toxicity remains controversial since the majority of cases are identified months or years after RA diagnosis and treatment initiation. It remains unknown if most interstitial lung disease (ILD)-RA cases present established fibrotic signs at diagnosis. The objectives of this work are: to describe the features of lung involvement during the first 5 years from RA diagnosis; to investigate the relationship between systemic disease activity parameters, treatments used for RA and smoking with the presence of lung abnormalities
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