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Higuchi T, Oka S, Furukawa H, Shimada K, Tsunoda S, Ito S, Okamoto A, Fujimori M, Nakamura T, Katayama M, Saisho K, Shinohara S, Matsui T, Migita K, Nagaoka S, Tohma S. Association of a Single Nucleotide Variant in TERT with Airway Disease in Japanese Rheumatoid Arthritis Patients. Genes (Basel) 2023; 14:2084. [PMID: 38003027 PMCID: PMC10671651 DOI: 10.3390/genes14112084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/11/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Interstitial lung disease and airway disease (AD) are often complicated with rheumatoid arthritis (RA) and have a poor prognosis. Several studies reported genetic associations with interstitial lung disease in RA. However, few genetic studies have examined the susceptibility to AD in RA patients. Here, we investigated whether single nucleotide variants susceptible to idiopathic pulmonary fibrosis might be associated with interstitial lung disease or AD in Japanese RA patients. Genotyping of rs2736100 [C/A] in TERT and rs1278769 [G/A] in ATP11A was conducted in 98 RA patients with usual interstitial pneumonia, 120 with nonspecific interstitial pneumonia (NSIP), 227 with AD, and 422 without chronic lung disease using TaqMan assays. An association with AD in RA was found for rs2736100 (p = 0.0043, Pc = 0.0129, odds ratio [OR] 1.40, 95% confidence interval [CI] 1.11-1.77). ATP11A rs1278769 was significantly associated with NSIP in older RA patients (>65 years, p = 0.0010, OR 2.15, 95% CI 1.35-3.40). This study first reported an association of rs2736100 with AD in RA patients and ATP11A rs1278769 with NSIP in older RA patients.
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Affiliation(s)
- Takashi Higuchi
- Department of Clinical Research, NHO Tokyo National Hospital, 3-1-1 Takeoka, Kiyose 204-8585, Japan; (T.H.); (S.O.); (S.T.)
| | - Shomi Oka
- Department of Clinical Research, NHO Tokyo National Hospital, 3-1-1 Takeoka, Kiyose 204-8585, Japan; (T.H.); (S.O.); (S.T.)
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan;
| | - Hiroshi Furukawa
- Department of Clinical Research, NHO Tokyo National Hospital, 3-1-1 Takeoka, Kiyose 204-8585, Japan; (T.H.); (S.O.); (S.T.)
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan;
| | - Kota Shimada
- Department of Rheumatology, NHO Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan;
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashi-dai, Fuchu 183-8524, Japan
| | - Shinichiro Tsunoda
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan;
- Department of Nephrology, Sumitomo Hospital, 5-3-20 Nakanoshima, Kita-ku, Osaka 530-0005, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Hon-cho, Shibata 957-0054, Japan;
| | - Akira Okamoto
- Department of Rheumatology, NHO Himeji Medical Center, 68 Hon-machi, Himeji 670-8520, Japan; (A.O.)
| | - Misuzu Fujimori
- Department of Rheumatology, NHO Himeji Medical Center, 68 Hon-machi, Himeji 670-8520, Japan; (A.O.)
| | - Tadashi Nakamura
- Department of Rheumatology, Sakurajyuji Hospital, 1-1-1 Miyukikibe, Minami-ku, Kumamoto 861-4173, Japan;
| | - Masao Katayama
- Department of Internal Medicine, NHO Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan;
| | - Koichiro Saisho
- Department of Orthopedics/Rheumatology, NHO Miyakonojo Medical Center, 5033-1 Iwayoshi-cho, Miyakonojo 885-0014, Japan;
- Tanimura Hospital, 10-2 Kitakoji, Nobeoka 882-0041, Japan
| | - Satoshi Shinohara
- Tochigi Rheumatology Clinic, 1-1-9 Ekimaedori, Utsunomiya 321-0964, Japan;
| | - Toshihiro Matsui
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan;
- Department of Rheumatology, NHO Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan;
| | - Kiyoshi Migita
- Clinical Research Center, NHO Nagasaki Medical Center, 2-1001-1 Kubara, Omura 856-8562, Japan;
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Shouhei Nagaoka
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, 1-21-1 Rokuura-higashi, Kanazawa-ku, Yokohama 236-0037, Japan;
| | - Shigeto Tohma
- Department of Clinical Research, NHO Tokyo National Hospital, 3-1-1 Takeoka, Kiyose 204-8585, Japan; (T.H.); (S.O.); (S.T.)
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan;
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2
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Poole JA, Mikuls TR, Thiele GM, Gaurav R, Nelson AJ, Duryee MJ, Mitra A, Hunter C, Wyatt TA, England BR, Ascherman DP. Increased susceptibility to organic dust exposure-induced inflammatory lung disease with enhanced rheumatoid arthritis-associated autoantigen expression in HLA-DR4 transgenic mice. Respir Res 2022; 23:160. [PMID: 35717175 PMCID: PMC9206339 DOI: 10.1186/s12931-022-02085-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Immunogenetic as well as environmental and occupational exposures have been linked to the development of rheumatoid arthritis (RA), RA-associated lung disease, and other primary lung disorders. Importantly, various inhalants can trigger post-translational protein modifications, resulting in lung autoantigen expression capable of stimulating pro-inflammatory and/or pro-fibrotic immune responses. To further elucidate gene-environment interactions contributing to pathologic lung inflammation, we exploited an established model of organic dust extract (ODE) exposure with and without collagen-induced arthritis (CIA) in C57BL/6 wild type (WT) versus HLA-DR4 transgenic mice. ODE-induced airway infiltration driven by neutrophils was significantly increased in DR4 versus WT mice, with corresponding increases in bronchoalveolar lavage fluid (BALF) levels of TNF-⍺, IL-6, and IL-33. Lung histopathology demonstrated increased number of ectopic lymphoid aggregates comprised of T and B cells following ODE exposure in DR4 mice. ODE also induced citrullination, malondialdehyde acetaldehyde (MAA) modification, and vimentin expression that co-localized with MAA and was enhanced in DR4 mice. Serum and BALF anti-MAA antibodies were strikingly increased in ODE-treated DR4 mice. Coupling ODE exposure with Type II collagen immunization (CIA) resulted in similarly augmented pro-inflammatory lung profiles in DR4 mice (relative to WT mice) that was accompanied by a profound increase in infiltrating lung CD4+ and CD8+ T cells as well as CD19+CD11b+ autoimmune B cells. Neither modeling strategy induced significant arthritis. These findings support a model in which environmental insults trigger enhanced post-translational protein modification and lung inflammation sharing immunopathological features with RA-associated lung disease in the selected immunogenetic background of HLA-DR4 mice.
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Affiliation(s)
- Jill A. Poole
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Ted R. Mikuls
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Geoffrey M. Thiele
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Rohit Gaurav
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Amy J. Nelson
- grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Michael J. Duryee
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Ananya Mitra
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Carlos Hunter
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Todd A. Wyatt
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA ,grid.266813.80000 0001 0666 4105Department of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Bryant R. England
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Dana P. Ascherman
- grid.21925.3d0000 0004 1936 9000Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
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Oka S, Furukawa H, Shimada K, Sugii S, Hashimoto A, Komiya A, Fukui N, Suda A, Tsunoda S, Ito S, Katayama M, Nakamura T, Saisho K, Sano H, Migita K, Nagaoka S, Tsuchiya N, Tohma S. Association of human leukocyte antigen alleles with chronic lung diseases in rheumatoid arthritis. Rheumatology (Oxford) 2016; 55:1301-7. [DOI: 10.1093/rheumatology/kew025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Indexed: 11/13/2022] Open
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Furukawa H, Oka S, Shimada K, Hashimoto A, Tohma S. Human leukocyte antigen polymorphisms and personalized medicine for rheumatoid arthritis. J Hum Genet 2015; 60:691-6. [PMID: 25903069 DOI: 10.1038/jhg.2015.36] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 03/12/2015] [Accepted: 03/12/2015] [Indexed: 01/11/2023]
Abstract
Human leukocyte antigen (HLA) polymorphisms are the most important genetic risk factors for rheumatoid arthritis (RA), a chronic systemic inflammatory disease of unknown etiology. Certain HLA-DRB1 alleles, known as shared epitope (SE) alleles because they have the same amino-acid sequence at positions 70-74, are associated with susceptibility to RA. A gene dosage effect is present for RA-predisposing SE alleles, and protective alleles show epistasis. An important role of amino-acid polymorphisms at positions 11 and 13 of the HLA-DRβ chain was also reported recently. Rheumatoid factor and anticitrullinated peptide antibodies are present in many RA patients. Similar to extra-articular manifestations, the presence of these autoantibodies is also associated with certain DRB1 alleles. Different frequencies of RA risk alleles in different ethnicities explain the varying prevalence of RA in different populations and suggest genetic heterogeneity of RA with regard to phenotype and population subsets. Some drug-induced hypersensitivity reactions due to disease-modifying antirheumatic drugs are also associated with HLA alleles. Understanding the role of HLA as the most important genetic factor relevant to RA susceptibility may help in determining its pathogenesis and pave the way to personalized medicine.
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Affiliation(s)
- Hiroshi Furukawa
- Clinical Research Center for Allergy and Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Japan
| | - Shomi Oka
- Clinical Research Center for Allergy and Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Japan
| | - Kota Shimada
- Department of Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Japan.,Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Atsushi Hashimoto
- Department of Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Japan
| | - Shigeto Tohma
- Clinical Research Center for Allergy and Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Japan
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5
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Different risk factors between interstitial lung disease and airway disease in rheumatoid arthritis. Respir Med 2012; 106:1591-9. [DOI: 10.1016/j.rmed.2012.07.006] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 07/09/2012] [Accepted: 07/16/2012] [Indexed: 12/19/2022]
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Abstract
This article reviews current understanding of the clinical manifestations, diagnosis and treatment of Sjögren's syndrome. Sjögren's syndrome is a chronic inflammatory disorder of the exocrine glands with multiple nonexocrine features. It is found predominantly in middle-aged women but exists throughout the population. The diagnosis of Sjögren's syndrome can be challenging because the cardinal sicca symptoms may be subclinical or attributed to other causes, such as medications or aging. Differential diagnosis of Sjögren's syndrome can be confounded by the multiple exocrine manifestations in the mouth, eyes, ears, nose, skin, vagina, and respiratory and gastrointestinal tracts, as well as seemingly unrelated nonexocrine involvement in the thyroid, liver, kidneys and the musculoskeletal, vascular and nervous systems. This article concludes that early diagnosis of Sjögren's syndrome is crucial to prevent and/or minimize potentially life-threatening complications. Periodic follow-up of patients' status and collaboration between the primary-care physician and the rheumatologist, dentist, ophthalmologist and other specialists are indispensable.
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Affiliation(s)
- Ibtisam Al-Hashimi
- Baylor College of Dentistry, Salivary Dysfunction Clinic, Department of Periodontics, 3302 Gaston Avenue, Dallas, TX 75246, USA and University of Texas Southwestern Medical Centre, Faculty of Surgery, Division of Oral Surgery, Dallas, TX, USA.
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Mori S, Koga Y, Sugimoto M. Small airway obstruction in patients with rheumatoid arthritis. Mod Rheumatol 2011; 21:164-73. [PMID: 21136133 PMCID: PMC3071934 DOI: 10.1007/s10165-010-0376-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 10/20/2010] [Indexed: 11/29/2022]
Abstract
This work was intended to evaluate the prevalence of obstructive small-airway disease in patients with rheumatoid arthritis (RA) and its association with clinical characteristics. Pulmonary function testing (PFT) and high-resolution computed tomography (HRCT) were performed on 189 consecutive RA patients. Each case was diagnosed based on abnormal HRCT findings. We defined obstructive dysfunction of small airways as a forced expiratory flow from 25% to 75% of vital capacity (FEF(25-75)) value >1.96 residual standard deviation (RSD) below predicted values. We found 19 patients (10.1%) with an interstitial pneumonia (IP) pattern and 15 (7.9%) with a bronchiolitis pattern; the other 155 (82.0%) had no abnormal HRCT patterns. In patients with neither abnormal pattern, median values of percentage predicted for carbon monoxide diffusing capacity (DL(CO)) and ratio of DL(CO) to alveolar ventilation (DLco/VA) were within the normal range, but median FEF(25-75), forced expiratory flow at 25% of vital capacity (V(25)), and V(25)/height were <70% of predicted values. Forty-seven patients (30.3%) in this group had obstructive small-airway dysfunction. Multivariate logistic regression analysis indicated that this type of abnormality is strongly associated with respiratory symptoms [odds ratio (OR) 5.18; 95% confidence interval (CI) 1.70-15.75; p = 0.012), smoking history (OR 2.78; 95% CI 1.10-6.99; p = 0.03), and disease duration >10 years (OR 2.86; 95% CI 1.27-6.48; p = 0.012). Parenchymal micronodules, bronchial-wall thickening, and bronchial dilatation on HRCT scans were also predictive factors for abnormal FEF(25-75), although these morphological changes were too limited for us to diagnose these patients with the bronchiolitis pattern. Obstructive dysfunction of small airways is apparently common among RA patients, even among those with neither the IP nor the bronchiolitis pattern on HRCT scans. Factors significantly associated with abnormal FEF(25-75) are respiratory symptoms, smoking history, and RA duration.
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Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Disease, NHO Kumamoto Saishunsou National Hospital, 2659 Suya, Kohshi, Kumamoto, 861-1196, Japan.
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Metafratzi ZM, Georgiadis AN, Ioannidou CV, Alamanos Y, Vassiliou MP, Zikou AK, Raptis G, Drosos AA, Efremidis SC. Pulmonary involvement in patients with early rheumatoid arthritis. Scand J Rheumatol 2009; 36:338-44. [DOI: 10.1080/03009740701393957] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
INTRODUCTION Lung disease is the most frequent and among the most severe extra-articular manifestation of rheumatoid arthritis (RA). Several interesting advances have been made in recent years in our understanding of this respiratory disease. STATE OF ART 1. The induction of BALT responsible for follicular lymphoid infiltrates has been demonstrated in the wall of respiratory bronchioles. These lymphoid infiltrates are similar to synovial and skin cellular infiltrates and secrete specific markers of RA (citrullinated proteins). These data strongly suggest a common pathogenic mechanism for RA in the joints and in other sites, such as the lung. 2. Improvements in high resolution computed tomography (HR- CT) increased the sensitivity of diagnosis. CT evidence of pulmonary disease is present in 50% of RA patients, but only 10% of these patients have clinical symptoms. The different lung manifestations, frequently combined, have been clearly described: pulmonary nodules (20%); small airways disease (30%): bronchiolitis, bronchiolectasis, and bronchiectasis; diffuse interstitial pneumonia of various types (20%). 3. Predictors of progression and therapeutic response remain unknown. Therefore treatment is empirical and based on usual indications and on drugs used in idiopathic fibrosis and other connective tissue pulmonary pathologies. CONCLUSIONS New biological drugs such as TNF blocking agents or anti CD20 antibody could be beneficial. Infections and drug-induced pneumonitis are not described in this review but must be considered systematically when an RA patient presents with lung involvement.
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Abstract
PURPOSE OF REVIEW To examine the role of lung disease in rheumatoid arthritis from a clinical, epidemiologic, pathophysiologic, and therapeutic perspective. RECENT FINDINGS Lung disease in rheumatoid arthritis is pleomorphic and has a marked adverse impact on the morbidity and premature mortality of patients with this disease. Recent advances in the understanding of the pathophysiology of lung disease associated with rheumatoid arthritis reveal it to be characterized by more active cellular infiltrates of both T cells and B cells, as well as other immunologically active cells, including mast cells, than many of the other forms of interstitial lung disease. Satisfactory treatment is lacking; available biologic response modifiers have been reported to have both beneficial and adverse effects on the lung. Newer approaches targeting cellular immunologic dysfunction including T-cell-directed and B-cell-directed therapies hold the promise of reducing lung damage related to the underlying disease. SUMMARY Lung disease in rheumatoid arthritis is a heterogeneous and oftentimes serious condition, with a profound impact on patient wellbeing and survival. Advances in the understanding of its etiology and targeted application of available, as well as development of new, more specific therapeutics will be of benefit to patients with rheumatoid arthritis who are suffering from lung disease.
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Kanat F, Levendoglu F, Teke T. Radiological and functional assessment of pulmonary involvement in the rheumatoid arthritis patients. Rheumatol Int 2007; 27:459-66. [PMID: 17028857 DOI: 10.1007/s00296-006-0234-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Accepted: 09/11/2006] [Indexed: 11/24/2022]
Abstract
The aim was to evaluate the findings of high resolution computed tomography (HRCT) and pulmonary function tests (PFT) in the rheumatoid arthritis (RA) patients with and without pulmonary symptoms and to determine their role in prediction of respiratory system involvement. Among 54 consecutive RA patients, 22 (41%) were symptomatic and 32 (59%) were asymptomatic after detailed respiratory examination. Abnormal findings in PFTs were present in 10 (45%) symptomatic and 15 (47%) asymptomatic patients. PFT results were similar in both groups. A total of 18 (82%) symptomatic and 16 (50%) asymptomatic patients had abnormalities in HRCT scans. About 16 (80%) of 20 patients with normal HRCT scans had no pulmonary symptoms at all and we noted a significant correlation (P < 0.05). HRCT was more useful mean than PFTs in evaluation of pulmonary involvement in the RA patients; however, no correlation was present between various respiratory symptoms and abnormal findings both in PFTs and HRCT scans.
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Affiliation(s)
- Fikret Kanat
- Department of Chest Diseases, Meram Medical School of Selcuk University, Konya, Turkey.
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12
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Abstract
Rheumatoid arthritis (RA) is a common, functionally disabling disease with genetic and environmental contributors. It occurs in approximately 1% of the population and adversely affects quality of life, functional status, and survival. Beyond its impact on the joints, pulmonary involvement occurs regularly and is responsible for a significant portion of the morbidity and mortality. Although pulmonary infection and/or drug toxicity are frequent complications, lung disease directly associated with the underlying RA is more common. The airways, vasculature, parenchyma, and pleura can all be involved, with variable amounts of pathologic inflammation and fibrosis. The true adverse clinical impact of the most important of these directly associated disorders, RA-associated interstitial lung disease (RA-ILD), has only recently begun to reveal itself. Our knowledge of the underlying pathobiology and the impact of our current immunomodulatory and biologic therapies on the lung disease are less than incomplete. However, what is clear is the importance of progressive lung fibrosis in shortening survival and impairing quality of life in RA as well as in other connective tissue diseases. The impact of historically available and newer biologic therapies in altering the outcome of RA-ILD is unknown; translational studies focused on the pathobiology and clinical studies focused on the treatment of RA-ILD are needed.
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Affiliation(s)
- Kevin K Brown
- Department of Medicine, National Jewish Medical and Research Center, University of Colorado Health Sciences Center, Denver, Colorado, USA.
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14
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Giles JT, Fernandes V, Lima JAC, Bathon JM. Myocardial dysfunction in rheumatoid arthritis: epidemiology and pathogenesis. Arthritis Res Ther 2005; 7:195-207. [PMID: 16207349 PMCID: PMC1257451 DOI: 10.1186/ar1814] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Data from population- and clinic-based epidemiologic studies of rheumatoid arthritis patients suggest that individuals with rheumatoid arthritis are at risk for developing clinically evident congestive heart failure. Many established risk factors for congestive heart failure are over-represented in rheumatoid arthritis and likely account for some of the increased risk observed. In particular, data from animal models of cytokine-induced congestive heart failure have implicated the same inflammatory cytokines produced in abundance by rheumatoid synovium as the driving force behind maladaptive processes in the myocardium leading to congestive heart failure. At present, however, the direct effects of inflammatory cytokines (and rheumatoid arthritis therapies) on the myocardia of rheumatoid arthritis patients are incompletely understood.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Animals
- Antibodies, Monoclonal/therapeutic use
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/epidemiology
- Arthritis, Rheumatoid/physiopathology
- Autoimmune Diseases/complications
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/physiopathology
- Comorbidity
- Cytokines/physiology
- Disease Models, Animal
- Double-Blind Method
- Etanercept
- Female
- Heart Failure/diagnostic imaging
- Heart Failure/epidemiology
- Heart Failure/etiology
- Humans
- Immunoglobulin G/therapeutic use
- Incidence
- Inflammation
- Infliximab
- Male
- Mice
- Mice, Transgenic
- Middle Aged
- Randomized Controlled Trials as Topic
- Receptors, Tumor Necrosis Factor/therapeutic use
- Risk Factors
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Tumor Necrosis Factor-alpha/physiology
- Ultrasonography
- Ventricular Dysfunction, Left/etiology
- Ventricular Remodeling/drug effects
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Affiliation(s)
- Jon T Giles
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Abstract
Interstitial lung diseases (ILDs) are a heterogeneous group of parenchymal pulmonary disorders with varying histologic appearances. Pulmonary function tests have gained a prominent role in the diagnosis and management of patients with these disorders. Although their role in the differential diagnosis of the various ILDs is limited, physiologic measurements are pivotal studies providing clues regarding disease severity, prognosis,and response to therapy.
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Affiliation(s)
- Vibha N Lama
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109-0360, USA
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16
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Fuld JP, Johnson MK, Cotton MM, Carter R, Watkin SW, Capell HA, Stevenson RD. A Longitudinal Study of Lung Function in Nonsmoking Patients With Rheumatoid Arthritis. Chest 2003; 124:1224-31. [PMID: 14555550 DOI: 10.1378/chest.124.4.1224] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE s: Patients with rheumatoid arthritis (RA) have a high prevalence of pulmonary function test (PFT) abnormality, but the long-term significance of this is unknown. We performed a longitudinal study of pulmonary function in asymptomatic, nonsmoking patients with active RA requiring disease-modifying drugs. We looked for temporal change in lung function and characteristics that would predict subsequent development of PFT abnormality or respiratory symptoms. METHODS In 1990, 52 patients (44 women; age range, 29 to 78 years; median, 56 years) underwent clinical assessment (drug history, RA severity, immunologic, and inflammatory markers) and PFTs (spirometry, body plethysmography, gas transfer). PFT results were expressed as standardized residuals (SRs). Thirty-eight patients were reassessed in 2000. A self-administered questionnaire was used to identify respiratory symptoms. RESULTS The prevalence of pulmonary function abnormality was higher than expected compared with a reference population, but there was no significant increase in number over 10 years (8.7% in 1990 and 8.8% in 2000). When assessed by group means and compared with reference values, reduced diffusing capacity of the lung for carbon monoxide (DLCO) and increased ratio of residual volume (RV) to total lung capacity (TLC) [RV/TLC] were the only abnormalities to develop over the study period (mean DLCO in 2000, - 0.47 SR; 95% confidence interval [CI], - 0.91 to - 0.01; RV/TLC, 0.49 SR; 95% CI, 0.13 to 0.84). However, rates of change of pulmonary function variables were not significantly different from zero. Logistic regression did not identify any meaningful relationship between disease characteristics and PFT abnormality. CONCLUSIONS Asymptomatic patients with RA have a higher prevalence of PFT abnormality than expected, but these do not increase in number over time. We did not identify any patient or disease-specific characteristic that could predict the development of respiratory disease in patients with RA. Analysis using percentage of predicted values, rather than SRs, is misleading as it exaggerates the extent of abnormality present. Abnormal lung function is a common and probably benign finding in nonsmoking, asymptomatic patients with RA.
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Affiliation(s)
- Jonathan P Fuld
- Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK.
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Alhamad EH, Lynch JP, Martinez FJ. Pulmonary function tests in interstitial lung disease: what role do they have? Clin Chest Med 2001; 22:715-50, ix. [PMID: 11787661 DOI: 10.1016/s0272-5231(05)70062-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pulmonary function tests have been widely accepted and utilized in the management of interstitial lung diseases. Although the tests performed have changed little over the past several decades, extensive literature has been published highlighting their clinical role in the diagnosis, staging, prognostication, and follow-up of patients with a wide variety of interstitial lung diseases.
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Affiliation(s)
- E H Alhamad
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, USA
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18
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Affiliation(s)
- M Cohen
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC
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19
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Abstract
Rheumatoid arthritis (RA) is the most common of the classic connective tissue diseases. Its manifestations in the chest are varied as the pleura, lung parenchyma, airways, and pulmonary vasculature can all be involved. The approach to a patient with RA and respiratory complaints, radiographic findings, or physiologic abnormalities requires a broad understanding of these manifestations. Moreover, the potential for therapy-related toxicity adds further complexity to the pulmonary evaluation of these patients.
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Affiliation(s)
- L T Tanoue
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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20
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Perez T, Remy-Jardin M, Cortet B. Airways involvement in rheumatoid arthritis: clinical, functional, and HRCT findings. Am J Respir Crit Care Med 1998; 157:1658-65. [PMID: 9603152 DOI: 10.1164/ajrccm.157.5.9710018] [Citation(s) in RCA: 179] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the present study was to assess the prevalence and characteristics of airways involvement in rheumatoid arthritis (RA) patients in the absence of interstitial lung disease. We prospectively evaluated, with high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs), 50 patients with RA (nine males and 41 females; mean age: 57.8 yr), including 39 nonsmokers and 11 smokers (mean cigarette consumption: 15.3 pack-yr) without radiographic evidence of RA-related lung changes. PFTs demonstrated airway obstruction (i.e., reduced FEV1/VC) in nine patients (18%) and small airways disease (SAD) (i.e., decreased FEF(25-75), defined as exceeding the predicted value by 1.64 residual SD [RSD] or more, and/or an increased phase III slope > 2 SD by single breath nitrogen washout) in four patients (8%). HRCT demonstrated bronchial and/or lung abnormalities in 35 cases (70%), consisting of air trapping (n = 16; 32%), cylindral bronchiectasis (n = 15; 30%), mild heterogeneity in lung attenuation (n = 10; 20%), and/or centrilobular areas of high attenuation (n = 3; 6%). Airway obstruction and SAD were correlated with the presence of bronchiectasis and bronchial-wall thickening (p = 0.003), and with bronchial infection (p = 0.01), but were unrelated to rheumatologic data. FEF(25-75) was reduced and the slope of phase III was increased in patients with airway changes on HRCT scans, whereas no PFT abnormalities were found in 13 of 15 patients with normal HRCT scans. HRCT depicted features of SAD in 20 of the 33 patients with normal PFTs. HRCT findings were unrelated to rheumatologic data. A high prevalence of airway abnormalities as assessed with HRCT and/or PFTs was observed in our RA population. HRCT appears to be more sensitive than PFTs for detecting small airways disease.
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Affiliation(s)
- T Perez
- Department of Pneumology, University Hospital of Lille, France.
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21
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Cortet B, Perez T, Roux N, Flipo RM, Duquesnoy B, Delcambre B, Rémy-Jardin M. Pulmonary function tests and high resolution computed tomography of the lungs in patients with rheumatoid arthritis. Ann Rheum Dis 1997; 56:596-600. [PMID: 9389220 PMCID: PMC1752273 DOI: 10.1136/ard.56.10.596] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the results of pulmonary function tests (PFTs) and high resolution computed tomography (HRCT) of the lungs in rheumatoid arthritis (RA) patients. METHODS Sixty eight patients (54 women, 14 men) fulfilling the revised criteria for RA were consecutively included in a transversal prospective study. Their mean age was 58.8 years (range: 35-82) and the mean duration of the disease was 12 years (range: 5-16). Rheumatoid factor was positive in 52 patients (76.5%). Fifty two patients (76.5%) were lifelong non-smokers. Detailed medical and drug histories were obtained. PFTs comprised spirometry and gas transfer measurements. Results for PFTs were expressed as percentage of predicted values for each individual adjusted for age, sex, and height. HRCT was undertaken with a Siemens Somatom Plus. RESULTS A significant decrease of FEV1/ FVC, FEF25%, FEF50%, FEF75%, FEF25-75%, and TLCO was observed (p < 0.05) and 13.2% of the patients had a small airways involvement defined by a decrease of FEF25-75% below 1.64 SD. The most frequent HRCT findings were: bronchiectasis (30.5%), pulmonary nodules (28%), and air trapping (25%). The patients with small airways involvement had a high frequency of recurrent bronchitis (75% v 34%, p = 0.05) and bronchiectasis (71% v 23%, p = 0.019). The patients with bronchiectasis were characterised by low values of FEV1, FVC, FEF25-75%, and TLCO (p < 0.01), a high prevalence of small airways involvement (29% v 5%, p = 0.019), and a low prevalence of HLA DQA1 *0501 allele (14% v 33%, p < 0.05). CONCLUSION This study suggests a significant association between small airways involvement on PFTs and bronchiectasis on HRCT in unselected RA patients.
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Affiliation(s)
- B Cortet
- Department of Rheumatology, CHRU Lille, Hôpital R Salengro, France
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22
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Despaux J, Toussirot E, Wendling D. [Bronchiectasis and rheumatoid arthritis. Incidence and etiopathogenic aspects. Review of the literature]. Rev Med Interne 1997; 18:144-52. [PMID: 9092034 DOI: 10.1016/s0248-8663(97)84681-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Many pleural and pulmonary manifestations are described in rheumatoid arthritis, due to the disease itself or drug-induced. A literature review revealed 289 reports of bronchiectasis since 1928, the respiratory symptoms preceding the articular features in 90%. Although the frequency of bronchiectasis in the general population is difficult to assess, and thus maybe underestimated, the prevalence in rheumatoid arthritis seems higher. Thus the recent studies, using modern processes such as high resolution computed tomography of the lungs, assess this association to about 25%. Nevertheless, the methodology of these studies is open to criticism, so the high frequency must be qualified. The pathogenic and aetiological factors remain unknown, and miscellaneous hypotheses, especially immunological, have been suggested. The relationship between both affections can not be asserted, but the association is unlikely to be fortuitous.
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Affiliation(s)
- J Despaux
- Service de rhumatologie, CHU Jean-Minjoz, Besançon, France
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23
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Abstract
STUDY OBJECTIVE To evaluate pulmonary findings in patients with primary Sjögren's syndrome (SS). DESIGN Prospective data collection. PATIENTS Seventeen consecutive nonsmoking patients with primary SS. MEASUREMENTS AND RESULTS Mild radiologic parenchymal changes were seen in two patients. Pulmonary hyperinflation (residual volume/total lung capacity [RV/TLC] percent ratio measured minus [-] RV/TLC percent ratio predicted > or = 8) was observed in 9 (53%) patients, whereas obstructive and restrictive changes were infrequently found in ordinary spirometry (FVC, FEV1, FEV%) (none and two cases, respectively). Patients with SS with hyperinflation had significantly lower maximal expiratory flow MEF50 (p < 0.05), MEF25 (p < 0.05), and higher total lung capacity (p < 0.05) and FRC (p < 0.05) values as compared with those patients with SS without hyperinflation. They were also more frequently dyspnoeic (six vs none, p < 0.02) and had higher mean serum beta 2-microglobulin levels (3.6 +/- 1.0 mg/L vs 2.6 +/- 0.7 mg/L, p < 0.025). The levels of serum beta 2-microglobulin correlated inversely with FVC (r = - 0.583, p < 0.01), FEV1 (r = - 0.533, p < 0.05), diffusing capacity for carbon monoxide (r = - 0.580, p < 0.01); its correlation with RV/TLC percent ratio was positive and relatively significant (r = 0.447, 0.05 < p < 0.10). CONCLUSIONS Pulmonary hyperinflation associated with diminished peripheral spirometric flow values is frequently found in patients with primary SS. This together with the correlation of disturbed lung function parameters to elevated serum beta 2-microglobulin levels suggests that lungs and especially small airways may be an usual target organ in primary SS.
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Affiliation(s)
- A Lahdensuo
- Dept. of Pulmonary Diseases, Tampere University Hospital, Pikonlinna, Finland
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Hassan WU, Keaney NP, Holland CD, Kelly CA. High resolution computed tomography of the lung in lifelong non-smoking patients with rheumatoid arthritis. Ann Rheum Dis 1995; 54:308-10. [PMID: 7763110 PMCID: PMC1005579 DOI: 10.1136/ard.54.4.308] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To define pulmonary involvement on high resolution computed tomography (HRCT) of the thorax in lifelong non-smoking rheumatoid arthritis patients and to relate the results to pulmonary function, bronchial reactivity, and a variety of clinical and serological factors. METHODS Twenty lifelong non-smoking RA patients (mean age 59 years (range 44-72; 18 females) were studied. Detailed medical and drug histories were taken. Protease inhibitor phenotype (Pi) and HLA-DR4 status were assessed. Schirmer's tear tests were performed to detect keratoconjunctivitis sicca (KCS). Spirometry, flow volume loops, and gas transfer factor measurement were recorded. The degree of bronchial reactivity (PC20 FEV1) was measured by a methacholine inhalation test. Chest and hand radiographs and HRCT of the lung were performed in all patients. RESULTS Thirteen patients were HLA-DR4 positive. Eighteen had the Pi MM and two the Pi MS phenotype. Eight patients had evidence of KCS on Schirmer's tear testing. Ten patients achieved PC20 FEV1 in the methacholine inhalation test. All the patients had normal chest radiographs and all showed evidence of erosive arthropathy on hand radiographs. Five patients (25%) showed basal bronchiectasis and one mild interstitial lung disease on HRCT. All five patients with bronchiectasis had the Pi MM phenotype, four had HLA-DR4, four had KCS and three achieved PC20 FEV1; these values were not significantly different (p > 0.05) from those in patients without bronchiectasis. CONCLUSION Using the highly sensitive technique of HRCT, we found evidence to suggest that the incidence of bronchiectasis in lifelong non-smoking RA patients may be much higher than previously reported.
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Affiliation(s)
- W U Hassan
- Department of Rheumatology, Leicester Royal Infirmary, United Kingdom
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Hassan WU, Keaney NP, Holland CD, Kelly CA. Bronchial reactivity and airflow obstruction in rheumatoid arthritis. Ann Rheum Dis 1994; 53:511-4. [PMID: 7944635 PMCID: PMC1005390 DOI: 10.1136/ard.53.8.511] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To investigate the prevalence of airways obstruction and bronchial reactivity to inhaled methacholine in rheumatoid arthritis patients and unselected controls. The control population consisted of patients attending the rheumatology department for minor degenerative joint problems. METHODS One hundred patients with rheumatoid arthritis (RA) [72 (72%) women, 28 (28%) men; mean (SD) age 58 (10) years] and fifty controls [30 (60%) women, 20 (40%) men; mean (SD) age 56 (9) years] were studied. Detailed medical, smoking and drug histories were taken; skin prick tests were performed to assess atopy and chest and hand radiographs were performed. Spirometry, flow volume loops and gas transfer factor measurement were performed to detect airflow obstruction and methacholine inhalation tests were carried out to assess bronchial reactivity. RESULTS There was no significant difference between rheumatoid arthritis patients and the controls in age, sex, smoking status and atopy on skin prick testing (p < 0.05). A significantly higher number of patients with RA had a history of wheeze compared with the controls (18% v 4%, p < 0.05). FEV1, FVC, FEV1/FVC, FEF25-75%, FEF25%, FEF50% and FEF75% were all significantly lower in the rheumatoid arthritis group (p < 0.05). A significantly higher number of patients with RA compared with controls showed bronchial reactivity to inhaled methacholine [55 (55%) v 8 (16%), p < 0.05]. FEV1, FVC, FEV1/FVC, FEF25-75%, FEF25%, FEF50% and FEF75% were all significantly lower among the patients with RA achieving PD20 FEV1 to inhaled methacholine (p < 0.05). CONCLUSION In unselected rheumatoid arthritis patients both airflow obstruction and bronchial reactivity are significantly increased compared with controls.
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Affiliation(s)
- W U Hassan
- Department of Rheumatology, Leicester Royal Infirmary, United Kingdom
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26
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McMahon MJ, Swinson DR, Shettar S, Wolstenholme R, Chattopadhyay C, Smith P, Johns P, Crosby NH. Bronchiectasis and rheumatoid arthritis: a clinical study. Ann Rheum Dis 1993; 52:776-9. [PMID: 8250608 PMCID: PMC1005187 DOI: 10.1136/ard.52.11.776] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To examine the relation between rheumatoid arthritis (RA) and bronchiectasis (BR). METHODS Disease activity, outcome, extra-articular manifestations, and laboratory features were compared in 32 patients with BR and RA (RA-BR group), 32 matched patients with RA without BR (RA group), and 31 patients with BR but without arthritis (BR group). RESULTS In 30 of the 32 (94%) patients with RA-BR, BR preceded RA. There was no functional or radiological difference between the RA-BR and RA groups, and except for xerophthalmia, which was more common in patients with RA-BR than patients with RA, there was no difference in extra-articular or laboratory features. CONCLUSIONS Bronchiectasis does not lead to a more aggressive disease course in RA and, despite the recognised association, BR is not an extra-articular manifestation of rheumatoid disease.
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Affiliation(s)
- M J McMahon
- Wrightington Hospital, Wigan, United Kingdom
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27
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Abstract
In summary, it appears that factors such as smoking and the presence of secondary Sjögren's syndrome might be important in predisposing the rheumatoid patient to the development of lung disease. Genetic factors may moderate or magnify these risks. At a cellular level, specific macrophage colonies within the lung may interact with a subgroup of CD4 T lymphocytes to produce unopposed B-cell activation, leading to local IgM production and the formation of immune complexes. This can damage lung both directly by cytolysis and indirectly by granulocyte recruitment through the release of neutrophil chemotaxins. Early in the evolution of these processes, steroids appear able to reduce lymphocyte numbers and prevent lung damage occurring, presumably by immunological mechanisms, while later they may reduce granulocyte numbers and activity, halting further progression of lung disease in some patients, perhaps by a direct anti-inflammatory effect. Confirmation of these mechanisms and the development of more specific therapeutic tools is probably dependent on studies which examine lung tissue directly by biopsy and may be aided by the application of more sensitive imaging techniques.
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Affiliation(s)
- C A Kelly
- Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
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28
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Lee JH, Suh GY, Lee KY, Yoo CG, Kim YW, Han SK, Shim YS, Kim KY, Han YC, Lee SD. Small airway disease in rheumatoid arthritis. Korean J Intern Med 1992; 7:87-93. [PMID: 1306077 PMCID: PMC4532112 DOI: 10.3904/kjim.1992.7.2.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Variety of pulmonary lesions are thought to be associated with rheumatoid arthritis (RA). These lesions traditionally have included pleurisy with or without effusion, Caplan's syndrome, pulmonary rheumatoid nodules, diffuse interstitial fibrosis, and pulmonary arteritis and hypertension. But little attention has been paid to the airways in RA. Recently, several reports have suggested an association between airflow limitation and RA, but its incidence is not known. Also whether there exists a parameter of disease activity of RA, suggesting the presence of small airway disease (SAD) is not clear. To answer these questions, the serologic parameters which reflect the disease activity of RA and pulmonary function tests which reflect small airway dysfunction were performed on 36 lifetime nonsmokers with RA who had normal chest x-ray findings. The prevalence of SAD and the relationships between the disease activity parameters of RA and pulmonary function were observed. The results were as follows. The percentages of patients with abnormal values for diffusing capacity, frequency dependence of compliance (C1.0/C0.0), forced expiratory flow 25-75%, Vmax50% and Vmax 75% were 45.5%, 62.5%, 40%, 22.8% and 11.4%, respectively. There was statistically significant negative correlation between C1.0/C0.0 and ESR. But consistent correlation between other pulmonary function tests and clinical and serologic parameters of RA, and differences in pulmonary function between patients who were serologically positive and negative for CRP and FANA, were not found. In conclusion, SAD, without the influence of smoking, is frequently associated with RA, but the presence of SAD cannot be predicted from any clinical and serologic parameters of RA currently in use.
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Affiliation(s)
- J H Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Chungjoo, Korea
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29
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Wise RA, Wigley FM, Scott TE, Hochberg MC. HLA-DQw alloantigens and pulmonary dysfunction in rheumatoid arthritis. Chest 1988; 94:609-14. [PMID: 3409744 DOI: 10.1378/chest.94.3.609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
HLA-DR4 and keratoconjunctivitis sicca (secondary Sjögren's syndrome) are associated with abnormal pulmonary function in patients with rheumatoid arthritis. Since recent investigations have found that much of the genomic polymorphism of the HLA-DR4 haplotype comes from the closely linked DQw allele, we reanalyzed this set of data to evaluate the relationship between the DQw allotypes and pulmonary function in rheumatoid arthritis. Using a step-wise regression analysis, we found that the presence of DQw1 was a stronger predictor of an abnormal forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and carbon monoxide diffusing capacity (D) than the presence of DR4, keratoconjunctivitis sicca, smoking status, or any other clinical parameter. DQw1-positive patients had a mean (+/- SD) percent of predicted FEV1, FVC, and D of 84.2 (+/- 19.8), 88.0 (+/- 17.9) and 85.6 (+/- 20.9) percent, respectively, all significantly lower than DQw-1 negative patients (p = 0.02, 0.02, and 0.03). Smokers with the heterozygous phenotype, DQw1/DQw3, tended to have obstructive disease of the airways, with a mean (+/- SD) FEV1 of 80.1 +/- 24.4 percent of predicted, compared to 95.7 +/- 12.1 percent of predicted in DQw1/DQw3-negative individuals (p = 0.03). Patients who had a DQw2 allele were more likely to have normal pulmonary function. We conclude that the HLA-DQw1 allotype is a strong predictor of abnormal pulmonary function and that it may identify smoking subjects with rheumatoid arthritis subjects who are prone to develop obstruction of airflow.
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Affiliation(s)
- R A Wise
- Department of Medicine, Francis Scott Key Medical Center, Baltimore 21224
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