ILD Unit, Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Feixa Llarga S/N, 08907, Barcelona, Spain.
Servei de Diagnòstic Per La Imatge El Prat (SDPI El Prat), Department of Radiology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain.
Sci Rep. 2020 Sep 24;10(1):15640. doi: 10.1038/s41598-020-72768-z.
Lung disease is common in patients with rheumatoid arthritis (RA). The onset of lung involvement in RA is not well known. The objective is to describe the features and evolution of lung involvement in early RA, its relationship with disease activity parameters, smoking and treatments. Consecutive patients with early RA without respiratory symptoms were included and tracked for 5 years. Lung assessment included clinical, radiological and pulmonary function tests at diagnosis and during follow-up. Peripheral blood parameters (erythrocyte sedimentation rate, C reactive protein, rheumatoid factor and anti-citrullinated peptide autoantibodies) and scales of articular involvement, such as DAS28-CRP, were evaluated. 40 patients were included and 32 completed the 5-year follow up. 13 patients presented lung involvement in the initial 5 years after RA diagnosis, 3 of them interstitial lung disease. Significant decrease of diffusion lung transfer capacity of carbon monoxide over time was observed in six patients, 2 of them developed interstitial lung disease. DLCO decrease was correlated with higher values of CRP and ESR at diagnosis. Methotrexate was not associated with DLCO deterioration or lung disease development. Subclinical progressive lung disease correlates with RA activity parameters. Smoking status and methotrexate were not associated with development or progression of lung disease.
肺部疾病在类风湿关节炎（RA）患者中很常见。RA 中肺部受累的发病机制尚不清楚。本研究旨在描述早期 RA 患者肺部受累的特征和演变，以及其与疾病活动参数、吸烟和治疗的关系。连续纳入无呼吸系统症状的早期 RA 患者，并进行 5 年随访。肺部评估包括诊断时和随访期间的临床、影像学和肺功能检查。评估外周血参数（红细胞沉降率、C 反应蛋白、类风湿因子和抗瓜氨酸化蛋白自身抗体）和关节受累评分，如 DAS28-CRP。共纳入 40 例患者，其中 32 例完成了 5 年随访。在 RA 诊断后的最初 5 年内，有 13 例患者出现肺部受累，其中 3 例为间质性肺病。6 例患者的一氧化碳弥散量随时间显著下降，其中 2 例发展为间质性肺病。DLCO 下降与诊断时 CRP 和 ESR 值较高相关。甲氨蝶呤与 DLCO 恶化或肺部疾病发展无关。亚临床进行性肺部疾病与 RA 活动参数相关。吸烟状况和甲氨蝶呤与肺部疾病的发生或进展无关。
