Anaya J M, Diethelm L, Ortiz L A, Gutierrez M, Citera G, Welsh R A, Espinoza L R
Department of Medicine, Louisiana State University School of Medicine, New Orleans, USA.
Semin Arthritis Rheum. 1995 Feb;24(4):242-54. doi: 10.1016/s0049-0172(95)80034-4.
Pulmonary involvement is one of the extra-articular manifestations of rheumatoid arthritis (RA) and includes pleurisy, parenchymal nodules, interstitial involvement, and airway disease. Rheumatoid pulmonary vasculitis is rare. Pulmonary disease also may be observed as a toxic event consequent to treatment for RA. Although RA is more common in women, rheumatoid lung disease occurs more frequently in men who have long-standing rheumatoid disease, positive rheumatoid factor and subcutaneous nodules. Pleural involvement, usually asymptomatic, is the most common manifestation of lung disease in RA and may occur concurrently with pulmonary nodulosis or interstitial disease. The clinical features and course of pulmonary fibrosis in RA are similar to those of idiopathic pulmonary fibrosis. Bronchiolitis obliterans organizing pneumonia (BOOP), which has been recently described in RA patients, has nonspecific clinical features. The histological patterns correspond to proliferative bronchiolitis in the airway and organizing pneumonia in the alveoli. Obstructive lung disease in RA includes obliterative bronchiolitis (OB) and bronchiectasis. OB is an acute illness characterized histologically by a constrictive bronchiolitis. It may be idiopathic or induced by D-penicillamine or intramuscular gold compounds. Methotrexate (MTX)-pneumonitis is an uncommon complication of MTX treatment. Its clinical presentation is not specific, and diagnosis must be made after exclusion of other causes of pulmonary diseases. It is uncertain if preexisting lung disease predisposes RA patients to MTX-pneumonitis. Treatment of lung disease in RA is empirical. Corticosteroids are usually administered and immunosuppressive drugs are often added when pulmonary disease progresses and/or steroid side-effects appear.
肺部受累是类风湿关节炎（RA）的关节外表现之一，包括胸膜炎、实质结节、间质性受累和气道疾病。类风湿性肺血管炎较为罕见。肺部疾病也可能是RA治疗后的毒性反应。尽管RA在女性中更为常见，但类风湿性肺病在患有长期类风湿病、类风湿因子阳性和皮下结节的男性中更为频发。胸膜受累通常无症状，是RA肺部疾病最常见的表现，可能与肺结节病或间质性疾病同时发生。RA中肺纤维化的临床特征和病程与特发性肺纤维化相似。最近在RA患者中描述的闭塞性细支气管炎伴机化性肺炎（BOOP）具有非特异性临床特征。组织学模式对应于气道中的增殖性细支气管炎和肺泡中的机化性肺炎。RA中的阻塞性肺病包括闭塞性细支气管炎（OB）和支气管扩张。OB是一种急性疾病，组织学特征为缩窄性细支气管炎。它可能是特发性的，或由D-青霉胺或肌肉注射金化合物诱发。甲氨蝶呤（MTX）肺炎是MTX治疗的一种罕见并发症。其临床表现不具特异性，必须在排除其他肺部疾病原因后才能做出诊断。目前尚不确定既往存在的肺部疾病是否会使RA患者易患MTX肺炎。RA肺部疾病的治疗是经验性的。通常给予皮质类固醇，当肺部疾病进展和/或出现类固醇副作用时，常加用免疫抑制药物。
