THE LUNGS IN RHEUMATOID-ARTHRITIS - A CLINICAL, RADIOGRAPHIC AND PULMONARY-FUNCTION STUDY

Objective. To determine the prevalence and spectrum of pulmonary abnor malities in patients with rheumatoid arthritis (RA) in a developing co untry. Design. This was a prospective hospital-based survey of a rando mly selected group of patients with RA who were seen in a rheumatic di seases unit. Setting. Groote Schuur Hospital and Princess Alice Orthop aedic Hospital, Cape Town. Patients. A group of 104 patients with RA w ere randomly selected from a total of 330 patients with RA who were se en in the rheumatic diseases unit, All the patients were interviewed a nd a clinical assessment, chest radiographs and pulmonary function tes ts were performed. Results. Fifty-six patients (53.8%) had evidence of one or more current or previous pulmonary diseases: rheumatoid nodule in 1 (1%), bronchiectasis in 2 (1.9%), fibrosing alveolitis in 5 (4.8 %), pneumonia in 5 (4.8%), asthma in 9 (8.7%), pleural disease in 17 ( 16.3%) and tuberculosis in 25 (24%), Excluding patients who were smoke rs or ex-smokers or who had coexistent pulmonary disease, there were 2 0 patients (19.2%) who had pulmonary abnormalities that could be attri buted to RA: rheumatoid nodule in 1 (1%), fibrosing alveolitis in 5 (4 .8%) (1 of whom also had pleural disease), pleural disease alone in 8 (7.7%), diffusion defect in 5 (4.8%) and airways obstruction in 1 (1%) . Conclusion. This study provides clinical and lung function criteria that allow a clinically useful stratification of abnormalities in rela tion to a spectrum of common causes of pulmonary dysfunction that need to be distinguished from pulmonary abnormalities caused by RA, Pulmon ary abnormalities are common and about 20% of RA patients may have an abnormality related to RA.