Pulmonary involvement in rheumatoid arthritis – Another face of the coin

Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune disorder that causes progressive, symmetric, erosive destruction of cartilage and bone, which is usually associated with autoantibodies production. It is common that articular signs and symptoms develop long before extraarticular signs, but sometimes lung involvement is the first manifestation of RA and the most aggressive feature of the disease. Respiratory symptoms can precede the articular symptoms in 10–20% of cases. However, they may be masked by the poor functional status from joint disease or chronic inflammation. The pulmonary involvement can be due to the chronic inflammation caused by the disease or it can be secondary to immune-modulating medication. The pulmonary disease due to the disease itself includes: interstitial lung diseases, airways involvement (large and small airways), pleural involvement, rheumatoid pulmonary nodules and vascular pathology. The most used medication in patients with RA, such as metotrexate, leflunomide, TNF alpha blockers, but also other used drugs, may cause pulmonary diseases.

Keywords

• rheumatoid arthritis
• pulmonary involvement
• interstitial lung disease
• drug toxicity