COMPLEX CLINICAL AND INSTRUMENTAL EVALUATION OF LUNG INJURY IN PATIENTS WITH RHEUMATOID ARTHRITIS

The damage of the respiratory system is a quite common  extra-articular manifestation  of rheumatoid  arthritis (RA). It is important  to note that its clinical symptoms occur in only 20–30% of patients; however, subclinical forms identified by active screening are observed in 70–80% of patients.

Objective: to compare the significance of pulmonary complaints,  the results of physical examination, and the data of instrumental  studies for the detection  of lung injury in patients with RA.

Subjects and methods. The study enrolled 70 RA patients (63 women and 7 men) aged 24 to 83 years. Only 10% of them had clinically evident lung injury associated with RA. Patients with other pulmonary diseases, such as asthma, chronic obstructive pulmonary disease, etc., were excluded. Physical examination, radiography/fluoroscopy, high-resolution computed  tomography (HRCT), single-photon emission computed  tomography (SPECT) of the lung, and lung function testing (LFT) with the determination of lung diffusion capacity.

Results and discussion. The data of physical examination  were nonspecific and unconvincing.  Pulmonary  complaints (dyspnea, cough, expectoration) were seen in 65% of the patients; an objective assessment revealed changes (vesiculotympanitic resonance,  harsh breathing, and pleural friction rub) in 40%. The X-ray films/fluorograms  displayed abnormalities (pulmonary fibrosis, focal changes) in only 10% of cases. 92% of the patients had lung HRCT  changes including moderate (bronchial  obstruction (40%), rheumatoid  nodules (10%), ground glass opacities (60%), bronchial thickening (20%), pleural effusion (10%), tree-in-bud opacities (3%)) and severe (pulmonary hypertension  (10%), bronchiectasis (10%), emphysema (5%) and lung tissue fibrotic changes as the honeycomb lung (2%)) ones. SPECT showed local hypoperfusion in the mantle and mediastinal parts of the lungs in 80% of cases. LFT analysis demonstrated reduced lung diffusion capacity in 41% of the patients, restrictive disorders in 30%, and bronchial obstruction in 70%.

Conclusion. Comparing the clinical and instrumental  findings permits one to diagnose subclinical lung injury in patients with RA. Thus, the early detection  of pulmonary involvement in RA requires the use of more sensitive methods.

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