Rheumatoid arthritis (RA) is a common inflammatory disease of the joints. It affects many joints, mainly the smaller joints of the hands and wrists, but also the larger ones. It causes painful joints with stiffness that is usually greater in the morning and over time leads to joint deformity and, eventually, a crippling condition. Effective treatments are available and therefore, early diagnosis and regular treatment with monitoring of disease activity are important to limit or prevent permanent damage.
Dr SK Chhabra, Senior Consultant, Pulmonary Medicine, Primus Superspeciality Hospital, Chanakyapuri, New Delhi shared his inputs in a recent IANS interview and laid out the facts about the two conditions and how lung disease and RA are linked to each other.
Can rheumatoid arthritis cause lung disease?
RA is more than just a joint disease. The inflammatory process also affects many other parts of the body. The lungs are most often affected, in addition to the skin, eyes, digestive tract, heart and blood vessels. There are many types of lung conditions that can occur in patients with RA. More than 25 percent of patients with RA will eventually develop lung conditions and diseases during their lifetime. If all patients with RA are screened for lung disease, evidence of lung involvement is found in more than half of people, even when there are no lung symptoms.
Lung disease is second only to heart disease and cancer as a cause of death in patients with RA. Lung disease due to RA is a major contributor to poor quality of life in addition to mortality. Often, lung disease follows joint involvement but rarely, RA may start as lung disease and later have joint manifestations.
What are the different lung diseases caused by rheumatoid arthritis?
The most common lung disease caused by rheumatoid arthritis is the narrowing of the lungs, called interstitial lung disease (ILD). Other lung conditions and diseases that can occur in RA include pulmonary nodules (one or more round masses of tissue of various sizes, likely confused with lung cancer), pleural effusion (protein-rich fluid in the sacs around the lungs), pleurisy. Are included. Obesity, bronchiectasis (dilation of the airways of the lungs leading to accumulation of secretions and infection in the lungs), bronchiolitis (deep narrowing of the airways in the lungs), pulmonary hypertension (high blood pressure in the arteries of the lungs) and lung infections such as pneumonia trend increases. The drugs that are used to treat RA normally suppress immunity which increases the risk of lung infections.
What is an interstitial lung disease?
ILD is a group of conditions with various causes characterized by a reduction in lung size due to fibrosis that usually worsens over time. RA is one of the more common causes of ILD. There are many types of ILD patterns and treatment, diagnosis and natural history differ according to the ILD pattern.
A patient with ILD becomes breathless on exertion, initially on running or fast walking, especially on an incline. This builds up over time and eventually causes breathlessness during activities of daily living such as getting dressed, bathing, or even eating. The oxygen level in the blood decreases during the initial stages of exertion and later even at rest. These patients require home oxygen to keep their oxygen in the normal range. Dry cough is another major symptom. Patients with ILD sometimes have sudden flare-ups, called acute exacerbations, which lead to severely worsening respiratory failure and carry a high risk of mortality.
Men, smokers, those with a longer history of joint disease, more active joint disease, and older age are at higher risk of developing ILD, but many RA patients who do not have any of these risk factors can develop ILD. Are.
How is ILD diagnosed and treated?
ILD is diagnosed with a chest exam, breathing tests called spirometry and diffusion capacity, and imaging including a plain chest radiograph and a high-resolution computed tomogram (HRCT) of the chest that provides clues to the pattern of ILD. In a case where the diagnosis of RA has already been established by clinical features and specific blood tests, a lung biopsy is not needed. Some of these tests are needed to evaluate disease progression as well as response over time after treatment is started.
Treatment of ILD due to RA has variable effect and may provide relief of symptoms
This is in addition to medications that are prescribed for other symptoms of RA, including joint disease. While effective treatments are now available for RA, depending on the severity and extent of the disease, treatment of lung diseases such as ILD is more difficult. Medicines that work for the joints generally do not work for the lungs. Drugs such as corticosteroids that suppress immunologically mediated immune damage have a variable response. For people who have increased lung fibrosis, a new class of drugs called antifibrotics may help slow the progressing shrinkage. Fibrosis is not reversible.
What are the treatments for other lung diseases caused by rheumatoid arthritis?
Management of a large pleural effusion will require drainage with a chest tube or a video-assisted thoracoscopy which is a minimal-access surgery. Treatment of lung infection requires appropriate antibiotics. Inhaled medications are needed to narrow the airways of the lungs.
What are the other treatment options for Interstitial Lung Disease?
In addition to medications, breathing exercises, and nutritional supplementation as needed is called pulmonary rehabilitation. It also reduces shortness of breath and improves exercise tolerance. Patients who are unable to maintain normal blood oxygen, which can be easily measured by pulse oximeter and blood gas analysis, require round-the-clock oxygen therapy. This can be given using an oxygen concentrator. Portable machines are also available.
The last resort for extensively scarred lungs is lung transplantation, a highly specialized and expensive surgery, which is now increasingly available in various cities in India.
What other remedies are recommended in rheumatoid arthritis ILD?
Along with quitting smoking, avoiding passive exposure and exposure to air pollution is very important. These patients are advised to get timely vaccination against influenza and pneumonia. Patients are encouraged to speak with their physician to ensure that medications are optimal for their joint symptoms, side effects are managed, and their lung health is monitored for early diagnosis and prompt action. She goes.
How can patients with rheumatoid arthritis know that they have lung problems?
Once you are diagnosed as having RA, an assessment for the presence of lung disease is advised as early lung disease may not cause any symptoms. Thereafter, prolonged cough, sputum, and most importantly, breathlessness with reduced exercise tolerance demands evaluation of a possible lung complication. Early diagnosis holds the best promise for a good response.