Pulmonary Manifestations of Rheumatic Disease in Asymptomatic Patients Save
![](/sites/default/files/styles/876_494/public/2020-05/lung%252Cbright_4.jpg)
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.
If you are a health practitioner, you may Login/Register to comment.
Due to the nature of these comment forums, only health practitioners are allowed to comment at this time.