2. Introduction
● Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by
symmetric, peripheral polyarthritis.
● The greatest incidence occurs between 35 and 45 years of age with predominance in women
of 3:1.
● It presents as a chronic, bilateral, and symmetrical erosive polyarthritis with diverse extra-
articular manifestations that affect tissues and organs, such as peripheral nerves, blood
vessels, the lung, eyes, heart, and spleen with the presence of rheumatoid nodules, anemia,
and symptoms of systemic disease.
● Three types of clinical course are recognized in this disease—type I, a self-limited process;
type II, a polycyclic variant; and type III, the most frequent, which is progressive and deforming.
The main causes of death are cardiovascular, pulmonary diseases, cerebrovascular,
neoplasia, and infections.
3. Pulmonary disease is a well-recognized and important extra-articular manifestation of RA
The aim of our study is to identify the pulmonary manifestations and its severity in patients
with RA.
4. MAterIAls And Methods
The present study was conducted in the Department of Medicine, Sardar Patel Medical
College and Associated Group of Hospitals Bikaner, Bikaner, Rajasthan, India. This study
was a cross-sectional, observational study.
Sample size: A total of 100 cases were included in the study.
Standard tests were used to analyze various parameters like the follows:
• Rheumatoid factor (RF) was measured by enzyme-linked immunosorbent assay (ELISA).
• C-reactive protein (CRP) test by latex agglutination.
• Erythrocyte sedimentation rate (ESR) by modified Westergren method
. • Anti-cyclic citrullinated peptide (CCP) antibody was measured by the second-generation
ELISA test.
• Chest X-ray posterior-anterior view digital.
5. ● pulmonary function test (PFT) by spirometry.
• high-resolution computed tomography (HRCT) chest.
The respiratory manifestation in RA include—
(1) parenchymal diseases like ILD and rheumatoid nodules,
(2) pleural diseases like pleurisy and pleural effusion,
(3) vascular diseases like pulmonary artery hypertension and diffuse alveolar hemorrhage,
(4) lower airway disease like bronchiectasis and bronchiolitis obliterans, and
(5) upper airway disease like cricoarytenoid arthritis.
6. Inclusion and Exclusion Criteria
Inclusion Criteria • All RA patients ≥16 years of age (the 2010 American College of Rheumatology/
European league against rheumatism classification criteria for RA).
Exclusion Criteria • Patients with a past and present history of smoking.
• Patients with preexisting pulmonary diseases like chronic obstructive pulmonary disease, asthma,
tuberculosis, pneumonia, etc
. • Patients with any connective tissue disorder other than RA.
• Patients who are critically ill. • Patients with chest and spine abnormalities like scoliosis and kyphosis.
• Patients on drugs affecting the pulmonary system, excluding the drugs used in RA.
• Pregnant or lactating females.
• Patients not willing to participate in the
7. RESULTS, LABS & RADIOLOGICAL FINDINGS
In the present study, pulmonary manifestation was present in a total of 38 patients (38%),
while the remaining 62 patients (62%) had no pulmonary manifestation.
The mean duration of disease in pulmonary manifestation absent cases was 7.47 ± 4.42
years, while in pulmonary manifestation present cases, the mean duration of disease was
9.97 ± 5.03 years (p < 0.05)
Table 1: Distribution of cases according to symptoms and signs
Table 2: Distribution of cases according to comorbid illness in relation to pulmonary
manifestation
Table 3: Distribution of cases according to serology in relation to pulmonary manifestation
Table 4: Distribution of cases according to PFT in relation to the pulmonary manifestatation
8.
9.
10.
11.
12. On HRCT, out of a total 38 pulmonary manifestation positive group,
ILD was found in 23 patients (60.5%) and was the most common finding,
followed by pleural effusion in 12 patients (31.5%),
a pulmonary nodule in four patients (10.5%), and
bronchiectasis in two patients (5.2%).
The most common pattern of ILD observed in the study was UIP in 14 patients (60.86%), followed
by nonspecific interstitial pneumonia in nine patients (39.13%).
13. DISCUSSION
● In the present study, pulmonary manifestations were there in 38 patients and the mean
age in this group was 56.11 ± 11.41 years (p < 0.01). Among 33 patients who had
comorbidity,
● 20 had pulmonary manifestation and this was found to be statistically significant (p =
0.015). PFT was abnormal in 33 out of 38 patients, with the most common pattern
being restrictive. Pulmonary manifestations were present in 19 out of 58 CRP-positive
patients and this was statistically significant (p < 0.05).
● The most common finding on HRCT was ILD, with UIP as the most common pattern.
● Also, the duration of the disease was significantly high in patients with pulmonary
manifestation, and the same has been demonstrated by other studies in the past
14. Limitation
● The study was conducted in a single center and it included patients who were already
on treatment.
● Drugs like methotrexate are known to have an impact on the respiratory system but our
study did not differentiate whether the effect on the respiratory system was because of
methotrexate or RA itself.
● To overcome this limitation, a randomized controlled trial is required.
15. CONCLUSION
● Our study shows the significant prevalence of pulmonary manifestations in patients
with RA. ILD was the most common manifestation, followed by pleural effusion.
● It is a systemic inflammatory disease and a major portion of morbidity and mortality are
due to its extra-articular manifestations.
● Thus, patients of RA, especially the ones with advanced age, long duration of disease,
and associated comorbidity, should be screened for pulmonary complications of RA
using X-ray chest and PFT supplemented by HRCT chest wherever required.
