Pulmonary manifestations in rheumatoid arthritis: A hospital based descriptive study

BACKGROUND: Pulmonary involvement in RA is a major source of morbidity and mortality. Lack of Indian studies in this prompted the present study. AIMS and Objectives- 1-To study the pulmonary manifestations of rheumatoid arthritis by clinical, radiological and physiological methods. 2-To identify the associations between lung manifestations and duration of the disease. MATERIALS AND METHODS: This study was conducted for 2 years in department of Pulmonary Medicine. One ninety cases of Rheumatoid Arthritis fulfilling ACR/EULAR 2010 criteria were screened for respiratory symptoms and evaluated. RESULTS: 1) Female patients with pulmonary symptoms outnumbered male patients[female:male=5.3:1]-. 2) Thirty eight(15%) out of 190 had significant pulmonary manifestations. 3) Usage of the DMARD was present in 78.9% of patients 4) Predominant respiratory symptom was dyspnea [73.6%] followed by hemoptysis [13.1%] and cough [10.52%]. 5) The predominant chest x-ray finding was reticulonodular in 16 [42.1%]. 6) Eight patients had normal HRCT [21.1%] and predominant lung abnormality in HRCT chest was bronchiectasis [42.1%] followed by interstitial lung disease [21%]. 7) Pulmonary hypertension was seen in 7 patients. 8) Twenty one [71%] patients had small airway obstruction. 9) DLCo was normal in 12 patients and reduced in 24 patients. CONCLUSIONS: 1) In RA patients having respiratory symptoms and with normal HRCT chest, PFT showed small airway dysfunction and hyperactive airway disease. Thus highlighting the importance of airway disease in RA patients. 2) Reduced DLCo can the earliest indicator of lung manifestation. DLCo reduction correlates with lung manifestation and not with Rheumatoid Arthritis disease duration.