Chest
Clinical InvestigationsA Longitudinal Study of Lung Function in Nonsmoking Patients With Rheumatoid Arthritis
Section snippets
Recruitment
In 1990, we recruited patients from the RA second-line medication clinic at the Centre for Rheumatic Diseases at Glasgow Royal Infirmary. All patients had RA diagnosed by a consultant rheumatologist, according to American College of Rheumatology criteria,11and were receiving one or more disease-modifying antirheumatoid drugs (DMARDs). Inclusion criteria were lifelong nonsmoking, no documented or recalled evidence of lung disease, and absence of respiratory symptoms on general inquiry at initial
Results
We studied 52 patients (44 women; age range, 29 to 78 years; median, 56 years). Thirty-eight patients were seropositive, and all were receiving DMARD therapy with a median lifetime use of two agents (range, one to four agents). The DMARDs used and the number of patients prescribed them are as follows: IM gold (n = 25), sulfasalazine (n = 22), penicillamine (n = 11), hydroxychloroquine (n = 8), methotrexate (n = 4), and azathioprine (n = 3). Only three patients had been solely administered
Discussion
There have been a considerable number of cross-sectional studies looking at the prevalence of pulmonary abnormalities in patients with RA who were not known to have lung involvement. The older studies451718192021222324used PFTs to detect the abnormalities, whereas in more recent times this has been combined with HRCT of the thorax6725262728; all studies concur in that a high prevalence of abnormality (35 to 65%) can be found. By contrast, 27% of our population had pulmonary function
Conclusions
We have demonstrated that, within a population of patients with RA selected as lifelong nonsmokers with no respiratory symptoms, the prevalence of pulmonary function abnormality is higher than expected when compared with a reference population, but did not increase over 10 years. Assessed by group means and SRs, both Dlco and RV/TLC became significantly abnormal in 2000 when compared with reference values. However, rates of change of pulmonary function variables were not significantly different
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