Pulmonary function in case of rhumatoid arthritis at a tunisian population

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Published May 6, 2013
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Vol. 91 No. 4 (2013): Issue Apr 2013

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H Ben Fredj
H. Ben Saad
N. Mhaouech
I. Bouajina
Z. Tabka
S. Rouatbi

Abstract

Background: The rheumatoid polyarthritis (PR) is a frequent pathology in Tunisia. The most frequent extra articular expression of this disease is in the respiratory tract.
aim: To determine the lung functional profile of PR of the Tunisian population by establishing possible relations between ventilatory variables and clinico-biological parameters of PR.
methods: It is a cross sectional study which concerned 87 patients (77 women) having a confirmed PR. They benefited from a measure of the lung function by a total physical Pléthysmography and by the technique of double transfer NO-CO. Clinical and biological checkup were realized.
results: Three kinds of pulmonary function defects were found: obstructive ventilatory defect (13%), restrictive defect (7%) and mixed defect (1%). Ventilatory flows and the lung volumes correlated negatively with the inflammatory syndrome (p<0.05). Alveolar-capillary diffusion capacity (DLco) was altered in an isolated way or associated with the respiratory functional syndromes (obstructive and restrictive) (6%). This abnormality had a vascular origin with an isolated fall of the lung capillary volume (Vc), a membrane origin with an isolated fall of the diffusion membrane (DM) or a combined origin with the decline of Vc and DM. This latter case was found at a late stage of PR. 58% of PR patients had a normal pulmonary function. Conclusion: All these functional findings were linked to PR itself (inflammatory and auto-immune origin) or to the lung toxicity due to the treatment by Methotrexate (alveolar and bronchial damage).

Keywords:

Rheumatoid polyarthritis, ventilatory flows, alveolar-capillary diffusion, membrane diffusion, capillary blood volume, Methotrexate

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References

  1. Saraux A. Epidémiologie de la polyarthrite rhumatoïde. La lettre de Rhumatologue 1999, 2000; 253: 18-21.
  2. Morel J, Miossec P, Combe B. Immunopathologie dans la polyarthrite rhumatoïde. EMC Rhumatologie Orthopédie 2004; 1: 218-30.
  3. Mazières B, Contragrel A, Constantin A. La polyarthrite rhumatoïde. Guide pratique des rhumatologues 1999; 307-27.
  4. Rat AC, Bissier MC. La polyarthrite rhumatoïde : coût direct et indirects. Rev rhum 2004; 71: 1122-9.
  5. Young A, Koduri G, Batley M et al. Early Rheumatoid Arthritis Study (ARAS) group. Mortality in rheumatoid arthritis. Increased in early course of disease, in ischemic heart disease and in pulmonary fibrosis. Rheumatology (Oxford) 2007; 46: 350-7.
  6. Ayhan Bilgici H, Ulusoy O, Kuru C. Pulmonary involvement in rheumatoid arthritis. Rheumatol Int 2005; 25: 429-35.
  7. Eli G, Richard T, Robert W et al. Interstitial Lung Disease in Recent Onset Rheumatoid Arthritis. Am J Respir Crit Care Med 1997; 156: 528-35.
  8. Sany J. La polyarthrite rhumatoïde de l'adulte, John Libbey Eurotext Ed 2003; pp 298.
  9. Khadadoh M.E, Joyakrishman B, Al-Gorair S et al. Effect of methotrexate on pulmonary function in patients with rheumatoid arthritis- a prospective study. Rheumatol Int 2002; 22: 204-7.
  10. Armett FC, Edworthy SM, Block DA et al. The American Rheumatism Association 1978 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-24.
  11. Prevoo ML. Modified disease activity scores that include twenty-eight-joint count, developpement and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995; 38: 44-8.
  12. Van Riel PL. Provisional guidelines for measuring disease activity in clinical trials on rheumatoid arthritis. Br J Rheumatol 1992; 31: 793-4.
  13. Sadoul P, Palu JM. Aspect clinique de la bronchite chronique. Bull Phsio Path Resp 1973; 9: 961-78.
  14. Ben Saad H, Ben Attia Saafi R, Rouatbi S, et al. Which definition to use when defining airflow obstruction? Rev Mal Respir 2007;24(3 Pt 1):323-30.
  15. Pride NB, Macklem PT: Lung mechanics in disease. In : Macklem PT, Mead J, eds. Handbook of physiology. The respiratory system. Mechanics of Breathing. Section 3, Vol. III, part 2. Bethesda, American Physiological Society 1986; pp 659-92.
  16. Brusasco V, Crapo R, Viegi G. Recommandations communes de l'ATS et de l'ERS sur les explorations fonctionnelles respiratoires. Rev Mal Respir 2006; 23: 17S7-17S10.
  17. Wanger J. Sprimétrie forcée. IN : Serroussi sadino. Exploration fonctionnelle pulomonaire : une approche pratique. Ed. Masson 1997: 1-69
  18. Manier G, Moinard J, Stoichef H. Pulmonary diffusing capacity after maximal exercise. J Appl Physiol 1993; 75: 2580-5.
  19. Borland CDR, Cox Y, Higenbottan T. Reduction of pulmonary capillary blood volume in patients with severe unexplained pulmonary hypertension. Thorax 1966; 51: 855-6.
  20. Borland CDR, Cox Y. Effect of varying alveolar oxygen partial pressure on diffusing capacity for nitric oxide and carbon monoxide, membrane diffusing capacity and capillary blood volume. Clin Sci 1991; 81: 759-65.
  21. Moinard J, Guénard H. Membrane diffusion of the lungs in patients with chronic renal failure. Eur Respir J 1993; 6: 225-30.
  22. Ueda T, Cheng G, Kuroki Y, et al. Effects of aging on surfactant forms in rats. Euro Respir J 2000; 15: 80-4.
  23. Li AM, Chan D, Wong E et al. The effects of obesity on pulmonary function. Arch Dis Child 2003; 88: 361-3.
  24. Krishnan E, Sokka T, Hannonen P. Smoking-gender interaction and risk for rheumatoid arthritis. Arthritis Res Ther 2003; 5: 158-62.
  25. Vergnenegre A, Pugnere N, Antonini MT et al. Airway obstruction and rheumatoid arthritis. Eur Respir J 1997; 10: 1072-8.
  26. Bienderer J, Schnabel A, Muhle G et al. Correlation between HRCT findings, pulmonary function tests and bronchoalveolar lavage cytology in interstitial lung disease associated with rheumatoid arthritis. Eur Radiol 2004; 14: 272-80.
  27. Combe B, Dougados M, Goupille P et al. Prognostic factors for radiographic damage in early rheumatoid arthritis. A multi parameter prospective study. Arthritis Rheum 2001; 44: 1736-43.
  28. Cortet B, Perez T, Roux N, Flipo RM et al. Pulmonary function tests and high resolution computed tomography of the lungs in patients with rheumatoid arthritis. Ann Rheum Dis 1997; 56: 596-600.
  29. Hassan WU, Keaney NP, Holland CD et al. Bronchial reactivity and airflow obstruction in rheumatoid arthritis. Ann Rheum Dis 1994; 53: 511-4.
  30. Tanone LT. Pulmonary manifestations of rheumatoid arthritis. Clin Chest Med 1998; 19: 667-85.
  31. Hargreaves MR, Mowat AG, Benson MK. Acute pneumonitis associated with low dose methotrexate treatement for rheumatoid arthritis: report of live cases and review of published reports. Thorax 1992; 47: 628-33.
  32. Buchbinder R, Hall S, Sambrook PN et al. Methotrexate Therapy in rheumatoid arthritis: a life table review of 587 patients treated in community practice. J Rheumatol 1993; 20: 639-44.
  33. Dayton, CS, Schwartz DA, Sprince NL et al. Low dose methotrexate may cause air trapping in patients with rheumatoid arthritis. Am J Respir Crit Care Med 1995; 151: 1189-93.