Rheumatoid arthritis lungs
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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From the American College of Rheumatology
Rheumatoid arthritis is the most common inflammatory form of arthritis.
It is a systemic disease, meaning it affects other organ systems besides the joints. One of the more serious complications is rheumatoid involvement of the lungs.
The most common respiratory manifestation of rheumatoid arthritis is pleuritis. Asymptomatic pleural disease can occur in up to 40% of patients with seropositive rheumatoid arthritis. The pleural effusions of rheumatoid arthritis typically have high protein levels and low glucose levels, but the white blood cell count is less than 5,000/microliter.
Rheumatoid nodules can sometimes be seen on pleural biopsy. Interstitial lung disease is more frequent in males than in females. Manifestations of interstitial lung disease include rheumatoid nodules, diffuse interstitial pneumonitis with or without pulmonary fibrosis, bronchiolitis obliterans, bronchiolitis obliterans with organizing pneumonia, bronchiectasis, and pulmonary hypertension.
Patients with rheumatoid arthritis are more susceptible to small-airways disease and emphysema, even in the absence of immunosuppressive therapy. In addition, many of the drugs used to treat rheumatoid arthritis, such as methotrexate, gold, penicillamine, and cyclophosphamide, can cause interstitial lung disease. Also, use of tumor necrosis factor (TNF) antagonists may lead to reactivation of tuberculosis and increased susceptibility to fungal infections.
Crackles may be heard when listening to the lungs with a stethoscope (auscultation). Alternatively, there may be decreased breath sounds or a "rub."
A chest X-ray may show abnormalities consistent with rheumatoid lung disease.
A CT scan of the chest may show abnormalities consistent with rheumatoid lung disease.
An echocardiogram may show pulmonary hypertension.
A thoracentesis (putting a needle into fluid around the lung) can provide the doctor access to pleural fluid that has the characteristics of rheumatoid lung disease.
A bronchoscopic, video-assisted, or open lung biopsy may show findings consistent with rheumatoid lung disease.
Chest x-rays are not sensitive enough to detect early or subtle interstitial lung disease. Pulmonary function testing, high-resolution computed tomography, bronchoalveolar lavage, or echocardiography is required to evaluate rheumatoid arthritis patients with pulmonary complaints. Cricoarytenoid involvement with rheumatoid arthritis can result in vocal cord dysfunction with manifestations ranging from hoarseness to upper airway obstruction with inspiratory stridor.
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