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Pulmonary Manifestations of Rheumatic Disease in Asymptomatic Patients

In clinical practice, pulmonary manifestations of rheumatic medical diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and peripheral spondyloarthritis (pSpA) are typically not screened for upon diagnosis of a rheumatic disease in patients without any signs or symptoms suggestive of pulmonary involvement. Yet, extraarticular manifestations of pulmonary involvement are not uncommon and can result in a substantial increase in morbidity and mortality. Thus, a way to detect asymptomatic patients at risk for pulmonary disease would be practice changing if it can be developed.

Abstract number 0409 (link) by L winter et al at the 2023 American College of Rheumatology Conference in San Diego, California was a prospective, longitudinal cohort study that examined the prevalence of both clinical and sub-clinical pulmonary manifestations in patients newly diagnosed with RA, PsA, and pSpA. This assessment was completed through a diagnostic workup that included patient history, a physical examination (breathing width < 3 cm and chest excursion < 8cm), and body plethysmography with diffusion capacity for carbon monoxide (DLCO), a 6-minute walk test, laboratory parameters (CRP, RF, and ACPA), and a CXR at the time of rheumatic medical disease diagnosis and every 3 months thereafter for a year. 

The study included 54 rheumatic patients (26 RA, 24 PsA, and 4 psPA) and 25 matched controls. An abnormal CXR suggestive of pulmonary impairment was diagnosed in 38% (24% RA, 10% PsA, 4% pSpA)) of rheumatic patients and, of these patients, only 36.8% experienced clinical symptoms of cough and/or dyspnea while 63.2% of these patients had subclinical/asymptomatic (no cough/dyspnea) pulmonary abnormalities, especially in those with a mean age of 57 years old and with an elevated rheumatoid factor (>14 IU/ml). 

In summary, the prevalence of pulmonary manifestations in afore-mentioned rheumatic medical diseases at diagnosis was more than one-third of these patients, with more than two-thirds of these patients presenting asymptomatically. Future studies are needed to further describe and validate a screening protocol to identify asymptomatic patients at risk for pulmonary manifestations.


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