Abstract
IntroductionLung involvement is a common extra-articular manifestation of rheumatoid arthritis (RA) that confers significant morbidity and mortality. The objective of the present study is to assess which respiratory symptoms and patient and disease characteristics are most highly associated with pulmonary function test (PFT) abnormalities in an RA patient cohort without clinical cardiovascular disease.MethodsA total of 159 individuals with RA and without clinically evident cardiovascular disease were evaluated. Respiratory symptoms were assessed with the Lung Tissue Research Consortium questionnaire and all patients underwent evaluation with PFTs. Demographic, lifestyle, RA disease and treatment characteristics were collected. Subclinical coronary artery disease was assessed by cardiac computed tomography. Multivariable regression analysis was used to identify pulmonary symptoms and nonpulmonary parameters associated with PFT abnormalities. Areas under the receiver operating characteristic curves (AUC) were calculated to evaluate the discrimination of these variables for identifying patients with PFT abnormalities.ResultsRespiratory symptoms were reported by 42% of the patient population. Although only 6% carried a prior diagnosis of lung disease, PFT abnormalities were identified in 28% of the subjects. Symptoms combined with other patient and RA characteristics (body mass index, current smoking, anti-cyclic citrullinated peptide antibodies, and current prednisone use) performed satisfactorily in predicting the PFT abnormalities of obstruction (AUC = 0.91, 95% confidence interval = 0.78 to 0.98), restriction (AUC = 0.79, 95% confidence interval = 0.75 to 0.93) and impaired diffusion (AUC = 0.85, 95% confidence interval = 0.59 to 0.92). Co-morbid subclinical coronary artery disease did not modify these relationships.ConclusionsAssessment of respiratory symptoms along with a limited number of clinical parameters may serve as a useful and inexpensive clinical tool for identifying RA patients in need of further pulmonary investigation.
Highlights
Lung involvement is a common extra-articular manifestation of rheumatoid arthritis (RA) that confers significant morbidity and mortality
We investigated the association of systemically assessed respiratory symptoms and patient and RA-related variables with impaired pulmonary function in a well-characterized cohort of 159 RA patients free of clinically evident cardiovascular disease (CVD)
In summary, we observed a high prevalence of pulmonary function test (PFT) abnormalities in a selected population of RA patients and a considerable frequency of respiratory symptoms as assessed by a formal questionnaire
Summary
Lung involvement is a common extra-articular manifestation of rheumatoid arthritis (RA) that confers significant morbidity and mortality. Clinicians may rely on development of overt respiratory symptoms (for example, dyspnea or cough) and/or physical findings (for example, basilar crackles) in RA patients as the trigger for evaluation for lung disease, an approach endorsed by the British Society of Rheumatology [19,21]. This approach has limited the understanding of the natural history of RA-associated lung disease by identifying patients primarily later in disease, and has contributed to the difficulty in assessing therapeutic agents for lung disease. Cardiovascular events, including myocardial infarctions and congestive heart failure, are increased twofold to fourfold in RA patients compared with matched non-RA controls [3,5,22,23]
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