Green Lane Respiratory Services, Auckland District Health Board, Private Bag 92024, Auckland 1142, New Zealand.
Respir Med. 2012 Oct;106(10):1441-6. doi: 10.1016/j.rmed.2012.06.020. Epub 2012 Jul 13.
Pulmonary disease is a well recognised and important extra-articular manifestation of rheumatoid arthritis (RA). The objective of this study was to determine the prevalence of airway and parenchymal abnormalities in newly diagnosed patients with RA and to correlate these with clinical measures of RA severity and laboratory tests.
60 patients with a new (symptom duration <12 months) diagnosis of RA (43 females, 42 European, mean age 54, 33 ever smoker, (17 current) underwent lung function testing and high resolution computed tomography (HRCT) scored by two independent radiologists.
Eighteen (30%) patients reported respiratory symptoms: dyspnoea (11), cough (11), and wheeze (8). Twelve (20%) patients had physiologic evidence of airflow obstruction and 24 (40%) had reduced gas transfer. The prevalence of HRCT abnormalities (in any lobe) was as follows: decreased attenuation 67%, bronchiectasis 35%, bronchial wall thickening 50%, ground glass opacification 18%, reticular changes 12%. All abnormalities were more common in the lower lobes. With the exception of reduced DLCO, there were no significant differences in the prevalence of HRCT patterns or lung function parameters between smokers and non smokers. Anti-CCP antibodies and rheumatoid factor (RF) correlated strongly with DLCO and variably with other physiologic measures but poorly with radiologic abnormalities.
Patients with newly diagnosed RA have a moderate prevalence of airway and parenchymal abnormalities on HRCT and lower than predicted lung function parameters which cannot entirely be explained by smoking. These data suggest that pulmonary involvement is present early in the disease course in RA.
肺部疾病是类风湿关节炎（RA）一种公认的重要关节外表现。本研究的目的是确定新诊断的 RA 患者气道和实质异常的患病率，并将其与 RA 严重程度的临床指标和实验室检查相关联。
60 例新诊断（症状持续时间<12 个月）的 RA 患者（43 名女性，42 名欧洲人，平均年龄 54 岁，33 名曾吸烟者，17 名当前吸烟者）接受了肺功能检查和高分辨率计算机断层扫描（HRCT）检查，由两位独立的放射科医生进行评分。
18 例（30%）患者报告有呼吸道症状：呼吸困难（11 例）、咳嗽（11 例）和喘息（8 例）。12 例（20%）患者存在气流阻塞的生理证据，24 例（40%）患者存在气体转移减少。HRCT 异常（任何肺叶）的患病率如下：衰减减少 67%、支气管扩张 35%、支气管壁增厚 50%、磨玻璃影 18%、网状改变 12%。所有异常在肺下叶更为常见。除了 DLCO 降低外，吸烟者和非吸烟者之间 HRCT 模式或肺功能参数的患病率没有显著差异。抗 CCP 抗体和类风湿因子（RF）与 DLCO 密切相关，与其他生理指标呈可变相关，但与放射学异常相关性较差。
新诊断的 RA 患者在 HRCT 上有气道和实质异常的中度患病率，以及低于预期的肺功能参数，这不能完全用吸烟来解释。这些数据表明，在 RA 病程早期就存在肺部受累。
