Pulmonary Disease Associated with Rheumatoid Arthritis

Introduction: Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with the production of autoantibodies. Although joint disease is the main presentation, there are a number of extra-articular manifestations, including lung disease. The prognosis varies according to the type and severity of the involvement. Objective: To characterize the patients with RA and lung disease followed by our centre. Methods: Review of clinical files between 2013-2020. Results: 121 patients (pts) were identified, 111 (91.7%) female and 10 (8.3%) male, with a median age of 62.46 years. 12 (9.9%) pts were smokers. 63 pts had positive rheumatoid factor (RF), 46 positive anti-cyclic citrullinated peptide antibodies (CCP) and 40 both positive. 33 (27.27%) pts had lung disease. Of these, 28 (84.9%) were female and 5 (15.2%) male, with a median age of 62.58 years. 8 pts (24.2%) were smokers. 23 pts had positive RF, 18 positive anti-CCP and 17 both positive. The median time until the diagnosis of lung disease was 5.17 years (maximum 15). In 3 pts, lung disease preceded joint disease. There were alterations in the parenchyma in 26 pts (2 with radiological pattern of NSIP, 1 of UIP, 1 of R-BILD and 1 of toxicity to methotrexate). There was airway disease (bronchiectasis) in 3, latent tuberculosis in 2, pulmonary thromboembolism in 1 and pleural disease in 1. It was found that smoking, positive RF and positive anti-CCP were statistically related to lung disease (p=0.002, p=0.016, p=0.023). There was no difference in disease control between patients with or without lung disease (75.75% vs 72.72%). Discussion: This review highlights the importance of screening of lung disease associated with RA, in order to optimize the follow-up of these pts.