Banks J, Banks C, Cheong B, Umachandran V, Smith A P, Jessop J D, Pritchard M H
Department of Respiratory Medicine, Llandough Hospital, Cardiff.
Q J Med. 1992 Nov-Dec;85(307-308):795-806.
Several studies have investigated lung function in patients with rheumatoid arthritis but have reached different conclusions. The main discrepancy has been between airways disease reported in 38-65 per cent of patients and interstitial pulmonary disease reported in 30-41 per cent. These variable results have probably arisen because specific lung disorders have often been diagnosed on the basis of non-specific tests of lung function which, when considered in isolation, are subject to different interpretations. We adopted a combined epidemiological and clinical approach to investigate lung function and respiratory symptoms in patients with rheumatoid arthritis. Epidemiological data showed that rheumatoid arthritis is associated with a mild restrictive lung defect with reductions in mean FEV1 and FVC of 0.26 l and 0.29 l respectively and a normal FEV1/FVC ratio. The reduction in mean maximum mid-expiratory flow rate of 0.34 l/s could be explained on the basis of lung restriction and there was no evidence of widespread airways dysfunction other than that which could be explained by cigarette smoking. The clinical study showed that abnormal lung function tests in individual patients were caused by a heterogeneous group of conditions which are frequently caused, or exacerbated, by cigarette smoking. Cigarette smoking, and not the rheumatoid process, was the most frequent cause of abnormal lung function in rheumatoid arthritis.
多项研究对类风湿关节炎患者的肺功能进行了调查，但得出了不同的结论。主要差异在于，报告显示38%至65%的患者存在气道疾病，30%至41%的患者存在间质性肺疾病。这些不同的结果可能是因为特定的肺部疾病往往是基于非特异性的肺功能测试诊断出来的，单独来看，这些测试容易有不同的解读。我们采用了流行病学和临床相结合的方法来调查类风湿关节炎患者的肺功能和呼吸道症状。流行病学数据显示，类风湿关节炎与轻度限制性肺缺陷有关，平均第一秒用力呼气容积（FEV1）和用力肺活量（FVC）分别降低0.26升和0.29升，FEV1/FVC比值正常。平均最大呼气中期流速降低0.34升/秒可以用肺限制来解释，除了吸烟可以解释的情况外，没有证据表明存在广泛的气道功能障碍。临床研究表明，个体患者肺功能测试异常是由多种不同情况引起的，这些情况经常由吸烟导致或加重。吸烟而非类风湿病程，是类风湿关节炎患者肺功能异常最常见的原因。
