Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E, Monument Street, 5th Floor, Baltimore, MD 21202, USA.
Arthritis Res Ther. 2010;12(3):R104. doi: 10.1186/ar3037. Epub 2010 May 27.
Lung involvement is a common extra-articular manifestation of rheumatoid arthritis (RA) that confers significant morbidity and mortality. The objective of the present study is to assess which respiratory symptoms and patient and disease characteristics are most highly associated with pulmonary function test (PFT) abnormalities in an RA patient cohort without clinical cardiovascular disease.
A total of 159 individuals with RA and without clinically evident cardiovascular disease were evaluated. Respiratory symptoms were assessed with the Lung Tissue Research Consortium questionnaire and all patients underwent evaluation with PFTs. Demographic, lifestyle, RA disease and treatment characteristics were collected. Subclinical coronary artery disease was assessed by cardiac computed tomography. Multivariable regression analysis was used to identify pulmonary symptoms and nonpulmonary parameters associated with PFT abnormalities. Areas under the receiver operating characteristic curves (AUC) were calculated to evaluate the discrimination of these variables for identifying patients with PFT abnormalities.
Respiratory symptoms were reported by 42% of the patient population. Although only 6% carried a prior diagnosis of lung disease, PFT abnormalities were identified in 28% of the subjects. Symptoms combined with other patient and RA characteristics (body mass index, current smoking, anti-cyclic citrullinated peptide antibodies, and current prednisone use) performed satisfactorily in predicting the PFT abnormalities of obstruction (AUC=0.91, 95% confidence interval=0.78 to 0.98), restriction (AUC=0.79, 95% confidence interval=0.75 to 0.93) and impaired diffusion (AUC=0.85, 95% confidence interval=0.59 to 0.92). Co-morbid subclinical coronary artery disease did not modify these relationships.
Assessment of respiratory symptoms along with a limited number of clinical parameters may serve as a useful and inexpensive clinical tool for identifying RA patients in need of further pulmonary investigation.
肺部受累是类风湿关节炎（RA）常见的关节外表现，可导致显著的发病率和死亡率。本研究的目的是评估在无临床心血管疾病的 RA 患者队列中，哪些呼吸症状以及患者和疾病特征与肺功能检查（PFT）异常相关性最高。
共评估了 159 名患有 RA 且无临床明显心血管疾病的患者。采用肺部组织研究联盟问卷评估呼吸症状，所有患者均接受 PFT 评估。收集人口统计学、生活方式、RA 疾病和治疗特征。采用心脏计算机断层扫描评估亚临床冠状动脉疾病。采用多变量回归分析识别与 PFT 异常相关的肺部和非肺部参数。计算受试者工作特征曲线（ROC）下面积（AUC），以评估这些变量识别 PFT 异常患者的能力。
42%的患者报告有呼吸症状。尽管只有 6%的患者有先前的肺部疾病诊断，但 28%的患者存在 PFT 异常。症状与其他患者和 RA 特征（体重指数、当前吸烟、抗环瓜氨酸肽抗体和当前泼尼松使用）相结合，可较好地预测阻塞性 PFT 异常（AUC=0.91，95%置信区间=0.78 至 0.98）、限制性 PFT 异常（AUC=0.79，95%置信区间=0.75 至 0.93）和弥散功能受损（AUC=0.85，95%置信区间=0.59 至 0.92）。共病亚临床冠状动脉疾病并未改变这些关系。
评估呼吸症状以及少数临床参数可能是一种有用且经济的临床工具，可用于识别需要进一步肺部检查的 RA 患者。
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