Lung Damage Common in RA

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Researchers from the Shin-Yokohama Yamasaki Clinic, report that almost half of rheumatoid arthritis patients show pulmonary abnormalities in computer-assisted tomography (CT) chest scans.

“Of 355 patients studied, high-resolution CT revealed pulmonary abnormalities in 177 patients, including 91 who were diagnosed with interstitial lung disease,”said medical director of the Shin-Yokohama Yamasaki Clinic, Yokohama, Japan, Masaomi Yamasaki, MD.

“Of those 91 patients, 12 were observed to have honeycomb lung, and those who were symptomatic were treated aggressively with high-dose steroids, cyclophosphamide, azathioprine, cyclosporine, and mycophenolate mofetil,”Yamasaki said during a presentation at the annual meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals. He noted that in three cases, the aggressive treatment appreared to have assuaged the progressive disease; while in the other two patients the disease continued to spread, leading to their death.

"Because of various factors that are unique to Japan and Japanese people, it could be that these findings are not in line with other ethnic, national or regional groups. We do not recommend routine CT for these patients because there is risk of radiation exposure."

However, he also mentions that findings of irregular chest x-rays or lung symptoms in rheumatoid arthritis patients should be investigated with supplemental imaging tests.

He noted that the honeycomb lung findings point to fibrotic changes that happen in end-stage interstitial lung disease and those fluctuations are linked to a poor diagnosis. Of the 12 patients who exhibited honeycomb lung patterns, five were discovered to have aggressive, symptomatic disease, the researchers reported.Lung Damage Common in RA

The findings corroborate that lung abnormalities arise frequently among patients diagnosed with rheumatoid arthritis and call for observation of lung disorders in this population, even among asymptomatic patients.

For this study, researchers observed and followed the patients at the hospital for 1 year. They were all given the high-resolution CT examinations on their original visit. The patients in the study consisted of 66 men and 289 women. The median age of the patients was 59.2 years and they had been diagnosed with rheumatoid arthritis for a median of 14.2 years.

The 177 abnormal lung CTs comprised of 154 cases of bronchitis or bronchiectasis; 91 cases of interstitial lung disease, including five symptomatic patients; 29 cases of emphysema; and one lung tumor.

Yamasaki said 26 men and 65 women were found to have interstitial lung disease. And of the 86 cases in which the finding occurred in asymptomatic patients, the researchers diagnosed 80 occurrences of non-septal linear attenuation; 18 cases of ground-glass attenuation; 12 cases of honeycombing; and 12 cases of extensive interstitial lung disease.

"This study suggests that when doctors are treating rheumatoid arthritis patients with pre-existing honeycombing lung they must be aware that rapidly progressive interstitial lung disease can develop," said Yamasaki.

"We are generally aware that rheumatoid arthritis patients are susceptible to cardiovascular abnormalities. However, we also have to be concerned about the lungs of patients with rheumatoid arthritis. Pulmonary complications are the second most common non-skeletal manifestation of rheumatoid arthritis. I don't think the Japanese study findings are unique to any nationality or ethnic group but broadly impact people living with rheumatoid arthritis,” said senior physician at Radboud University, Nijmegen, the Netherlands, Inger Meek, MD.

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