Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil.
Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
Braz J Med Biol Res. 2021 Mar 15;54(5):e10040. doi: 10.1590/1414-431X202010040. eCollection 2021.
Although pulmonary involvement is the most common extra-articular manifestation of rheumatoid arthritis (RA), traditional pulmonary function tests (PFTs) do not show a good correlation with the field tests usually performed in these patients. In recent decades, measurement of ventilation distribution heterogeneity through the nitrogen single-breath washout (N2SBW) test and evaluation of functional capacity during exercise using the Glittre activities of daily living test (GA-T) have been increasingly used. Therefore, the objective of this study was to evaluate predictors of GA-T outcomes in women with RA considering demographic, anthropometric, clinical, functional variables, and chest computed tomography (CT) findings. Forty-three women with RA underwent the GA-T, the N2SBW test, spirometry, measurement of the diffusing capacity for carbon monoxide (DLco), measurement of respiratory muscle strength, and evaluation of physical function of the lower and upper limbs through the Health Assessment Questionnaire Disability Index (HAQ-DI). Chest CT scans were analyzed retrospectively. The GA-T time showed significant correlations with the DLco (rs=-0.397, P=0.008), forced vital capacity/DLco (rs=0.307, P=0.044), phase III slope of the N2SBW test (SIIIN2, rs=0.644, P<0.0001), and the HAQ-DI (rs=0.482, P=0.001). Disease extent as assessed by chest CT was associated with the GA-T time. On multiple regression analysis, the SIIIN2 and HAQ-DI were the only predictors of the GA-T time, explaining 40% of its variability. Thus, ventilation distribution heterogeneity and worse physical function substantially explain the variability in GA-T time in women with RA and varying extents of disease on chest CT.
虽然肺外表现是类风湿关节炎（RA）最常见的关节外表现，但传统的肺功能检查（PFT）与这些患者通常进行的现场检查相关性并不理想。近几十年来，通过氮单呼吸冲洗（N2SBW）试验测量通气分布异质性以及通过 Glittre 日常生活活动测试（GA-T）评估运动时的功能能力已经越来越多地应用。因此，本研究的目的是评估考虑到人口统计学、人体测量学、临床、功能变量和胸部计算机断层扫描（CT）发现的情况下，女性 RA 患者 GA-T 结果的预测因素。43 名 RA 女性患者接受了 GA-T、N2SBW 试验、肺活量测定、一氧化碳弥散量（DLco）测量、呼吸肌力量测量以及通过健康评估问卷残疾指数（HAQ-DI）评估上下肢的身体功能。胸部 CT 扫描进行回顾性分析。GA-T 时间与 DLco（rs=-0.397，P=0.008）、用力肺活量/DLco（rs=0.307，P=0.044）、N2SBW 试验 III 期斜率（SIIIN2，rs=0.644，P<0.0001）和 HAQ-DI（rs=0.482，P=0.001）显著相关。胸部 CT 评估的疾病程度与 GA-T 时间相关。在多元回归分析中，SIIIN2 和 HAQ-DI 是 GA-T 时间的唯一预测因素，解释了其变异性的 40%。因此，通气分布异质性和更差的身体功能在很大程度上解释了女性 RA 患者和胸部 CT 上疾病程度不同的 GA-T 时间的变异性。
