Rheumatoid arthritis lungs
Rheumatoid arthritis is the most common inflammatory form of arthritis. 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 nodulosis, 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, a "rub," or normal breath sounds. 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) may show characteristics of rheumatoid lung disease. A bronchoscopic, video-assisted, or open lung biopsy may show findings consistent with rheumatoid lung disease. Chest radiographs are too insensitive to be of value in the assessment of 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 arthritis can result in vocal cord dysfunction with manifestations ranging from hoarseness to upper airway obstruction with inspiratory stridor.
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