Dhali Arkadeep, Biswas Dijendra Nath, Maity Rick, Biswas Jyotirmoy, Bharadwaj Hareesha Rishab, Kumar Bharat, Singh Archana, Mitra Ritabrata, Ghosh Parasar
Institute of Post Graduate Medical Education and Research, Kolkata, India.
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Ann Med Surg (Lond). 2025 Apr 15;87(6):3178-3182. doi: 10.1097/MS9.0000000000003301. eCollection 2025 Jun.
Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints but also leading to significant extra-articular manifestations. Pulmonary involvement in RA, especially interstitial lung disease (ILD), contributes substantially to morbidity and mortality. This study aims to evaluate the prevalence and pattern of lung involvement in RA patients and correlate these findings with spirometric indices.
In this cross-sectional study, a total of 50 RA patients aged 18-55 years, diagnosed according to ACR-EULAR criteria, were enrolled. All participants underwent spirometry to measure FEV1, FVC, and FEV1/FVC ratios. Additionally, high-resolution computed tomography (HRCT) of the thorax was performed to identify patterns of lung involvement, including ground-glass opacity, honeycombing, interstitial thickening, and fibrosis. Statistical analyses were used to explore associations between disease duration, spirometric indices, and HRCT findings.
Lung involvement was observed in 30 (60%) patients, with ground-glass opacities in 16 (32%) and interstitial thickening in 14 (28%) patients. ILD was detected in 13 (26%) patients, with usual interstitial pneumonia being the predominant pattern in 9 (69.2%) cases. A significant correlation was found between longer disease duration (>5 years) and the presence of abnormal spirometry findings (odds ratio [OR] = 16.0, 95% CI: 3.527-72.583, = 0.000326; 63.2%, = 12) as well as abnormal HRCT findings (OR = 6.476, 95% CI: 1.563-26.836, = 0.01; 84.2%, = 16). Patients with abnormal spirometry had significantly higher odds of showing abnormal HRCT findings (OR = 35.0, 95% CI: 7.629-160.719, = 0.000084).
Abnormal HRCT findings and spirometry patterns correlate significantly with longer disease duration in RA. Early detection and management of pulmonary complications in RA may improve patient outcomes, particularly in those with long-standing disease. Furthermore, longitudinal studies are required to fully comprehend ILD progression in RA and its impact on patient prognosis.
类风湿关节炎（RA）是一种慢性自身免疫性疾病，主要影响关节，但也会导致明显的关节外表现。RA患者的肺部受累，尤其是间质性肺疾病（ILD），在发病率和死亡率方面起了很大作用。本研究旨在评估RA患者肺部受累的患病率和模式，并将这些发现与肺功能指标相关联。
在这项横断面研究中，共纳入了50例年龄在18至55岁之间、根据美国风湿病学会（ACR）和欧洲抗风湿病联盟（EULAR）标准确诊的RA患者。所有参与者均接受肺功能测定以测量第一秒用力呼气容积（FEV1）、用力肺活量（FVC）和FEV1/FVC比值。此外，还进行了胸部高分辨率计算机断层扫描（HRCT）以确定肺部受累模式，包括磨玻璃影、蜂窝状改变、间质增厚和纤维化。采用统计学分析来探讨疾病持续时间、肺功能指标和HRCT结果之间的关联。
30例（60%）患者出现肺部受累，其中16例（32%）有磨玻璃影，14例（28%）有间质增厚。13例（26%）患者检测出ILD，其中9例（69.2%）以普通型间质性肺炎为主。发现疾病持续时间较长（>5年）与肺功能测定结果异常（优势比[OR]=16.0，95%可信区间：3.527 - 72.583，P=0.000326；63.2%，n=12）以及HRCT结果异常（OR=6.476，95%可信区间：1.563 - 26.836，P=0.01；84.2%，n=16）之间存在显著相关性。肺功能测定结果异常的患者出现HRCT结果异常的几率显著更高（OR=35.0，95%可信区间：7.629 - 160.719，P=0.000084）。
RA患者中，HRCT结果异常和肺功能测定模式与较长的疾病持续时间显著相关。早期发现和处理RA患者的肺部并发症可能改善患者预后，尤其是那些患有长期疾病的患者。此外，需要进行纵向研究以全面了解RA中ILD的进展及其对患者预后的影响。
