A Study on Pulmonary Manifestations of Rheumatoid Arthritis

Introduction: In approximately 50%, are Rheumatoid Arthritis (RA), there are extra articular manifestations. Pulmonary involvement ranges between 10%-67%. Interestingly, mortality in patients of RA is further increased with extra-articular affection, among which pulmonary involvement accounts for 10-20% mortality. Aim: To evaluate the spectrum, relevant factors and frequency of pulmonary affection in diagnosed patients of RA. Materials and Methods: A cross-sectional, study was done in RG Kar Medical College, a tertiary care teaching hospital of Kolkata, India. A total of 63 consecutive patients of RA were enlisted and evaluated - clinically, High Resolution Coaxial Tomography (HRCT) scan of thorax, spirometry and echocardiography. Results: About one third (n=19) of the RA patients had respiratory symptoms; half (n=31) showed abnormal spirometry results and less than half (n=28) had some abnormality in HRCT. The most common abnormality was decreased attenuation, found in 36.5% patients. Others were bronchiectasis (n=19, 30.2%), bronchial wall thickening (n=16, 25.4%), pulmonary nodules (n=3, 4.8%), pleural effusion (n=10, 15.9%), pleural thickening (n=5, 7.9%), ground glass opacity (n=6, 9.5%), reticulo-nodular shadow (n=8, 12.7%) and air trapping (n=11, 17.5%). Pulmonary Hypertension (PH) was found in about one quarter (n=17) of the study population and in about half (n=8) of them it was clinically silent. Conclusion: Pulmonary manifestations are quite common in RA and they often remain clinically silent particularly in early part of the disease. They increase with duration of RA and age of the patient with exception of pleural effusion which is more prevalent early in the disease. Pulmonary evaluation should be considered early in RA patients irrespective of having any respiratory symptoms.