NEW YORK (Reuters Health) Oct 20 - Not all lung diseases associated with rheumatoid arthritis turn out the same, researchers from Japan reported online September 30th in the European Respiratory Journal.
"Lung disease directly associated with rheumatoid arthritis (LD-RA) includes a variety of diseases," Dr. Yutaka Tsuchiya from Saitama Cardiovascular and Respiratory Center told Reuters Health by email. "In our study, we show that treatment strategies and prognoses vary depending on each disease."
Dr. Tsuchiya and colleagues reviewed 144 patients with pleuropulmonary complications directly associated with rheumatoid arthritis.
Among these 144 patients, 57 had usual interstitial pneumonia, 31 had bronchiectasis, 16 had nonspecific interstitial pneumonia, 11 had bronchiolitis, 5 had organizing pneumonia, 5 had diffuse alveolar damage, and 19 had combined disease.
Usual interstitial pneumonia, organizing pneumonia, and diffuse alveolar damage were more common in men and smokers, whereas bronchiectasis was more common in patients with younger age at onset of rheumatoid arthritis, in those with a longer period between rheumatoid arthritis onset and LD-RA diagnosis, and in those not taking corticosteroids.
High-resolution CT scans showed similar patterns in patients with usual interstitial pneumonia, nonspecific interstitial pneumonia, diffuse alveolar damage, and bronchiectasis.
Only a minority of patients with usual interstitial pneumonia (13/57) or nonspecific interstitial pneumonia (3/16) received treatment (most commonly steroid therapy), whereas 3 of 5 patients with organizing pneumonia were given steroids and all 5 patients with diffuse alveolar damage received corticosteroid pulse therapy and cyclophosphamide.
Median survival ranged from 0.2 years for patients with diffuse alveolar damage to 9.9 years with usual interstitial pneumonia, 9.3 years with bronchiolitis, and 17 years with nonspecific interstitial pneumonia.
Five- and 10-year survival rates were 93.8% and 93.8% for nonspecific interstitial pneumonia, 87.1% and 81.7% for bronchiectasis, 88.9% and 47.4% for bronchiolitis, 60.0% and 60.0% for organizing pneumonia, 36.6% and 24.6% for usual interstitial pneumonia, and 20% and 0% for diffuse alveolar damage.
"We would like physicians to know from our study that although the prognoses of LD-RA are by no means good, this does not mean that all prognoses of LD-RA are poor," Dr. Tsuchiya said. It's "very important to investigate which kind of LD-RA the patient has developed."
"To our surprise, few deaths were caused by lung infections," Dr. Tsuchiya added. Of the 144 patients, 71 died during a median follow-up of 4.5 years, with 58 of the deaths due to respiratory lesions.
"As our study also suggests, a thoracoscopic lung biopsy should be performed only if the diagnosis is difficult to make," Dr. Tsuchiya said. "Most cases can be diagnosed on the basis of clinical features, imaging findings, and lung function."
"LD-RA patients who have been affected by antirheumatic drugs frequently suffer from lung infections. However, most of these infections are treatable. Therefore, we suppose that the actual frequency of death caused by infectious diseases was less than the impression we got through our medical practice."
http://erj.ersjournals.com/content/early/2010/09/30/09031936.00019210
this isn't a good read for me today.
I've had bronchitis which has developed into pneumonia despite being on increasing doses of antibiotics and 50 mg. prednisone
The stats are scary.