3Maryam Ali Y Al-Nesf, 1Mousa Shaher Hussein, 2Fiaz Alam, 3Sami Aqel, 1Tasleem Raza, 1Hisham A Sattar, 2Samar Alemadi
1Hamad Medical Corporation, 2Rheumatology Division, Department Of Medicine, Hamad Medical Corporation, 3Allergy & Immunology Division, Department of Medicine, Hamad Medical Corporation
Background:
A wide range of pulmonary findings can complicate rheumatoid arthritis (RA) or toxicity from its treatment. The overall frequency was estimated to be 25.8% in KSA, while data are scares in other parts of the Middle East. This study aims to evaluate the rate of lung findings and associated risk factors in patients with RA in Qatar.
Method(s):
A retrospective chart review was done for patients diagnosed with RA, retrieved from the rheumatology division data registry (12/2019-12/20210) at a tertiary hospital in Qatar. All types of lung presentations (clinical and radiological) were analyzed.
Result(s):
A total of 744 patients with RA, an F: M ratio of 2.4:1, and a median (IQR) age of 51 (60-41) years were included in the final analysis. The presence of mixed connective tissue disorders accounted for 13.6% of patients. Methotrexate, hydroxychloroquine, and sulfasalazine dominated the drug of choice in patients with or without lung manifestations (59.4%, 25.3%, and 10.6% of patients, respectively) followed by leflunomide (10.5%), tofacitinib (7.3%), rituximab (6.0%), and certolizumab (4.2%). The pulmonary diseases were identified in 58 (7.8%) patients in the following order ILD (NSIP) 11 (19%), pulmonary nodule 11 (19%), asthma 10 (17.2%), bronchiectasis 9 (15.5%), ILD (UIP) 6 (10.3%) and OSA 3 (5.2%). COOP, malignancy (lymphoma, Mets), and Pulmonary HTN presented in 2 patients for each, while pulmonary embolism, pericardial effusion, and pleural effusion complicated a single patient for each. Almost all patients had lung radiology at one stage in their records. Abnormal radiological findings were also identified without symptoms in only 15 out of the remaining 686 patients (2.2%) in the form of old tuberculosis scaring (5), lung nodules (3), and congenital anomalies (congenital absence of R pulmonary artery, and dextrocardia-situs inversus) (2), diffuse fine reticular shadowing (2), ground glass opacity and/or mosaic changes (3) and focal bronchiectasis (1). “Non-specific Increased broncho-vascular markings” were present in most CXR of patients with no symptoms. Lung function assessment was utilized in 51 patients with a mean (SD) of FEV1%, FVC%, and FEV1/FVC% of 78.6 (18.9), 79.8 (15.8), 81.9 (10.3), respectively. The COVID-19 pandemic contributed to transient lung manifestations in 267 patients over the last 2 years, and 2 patients had the infection twice (almost a year apart). Among these patients, 39 were admitted, and two died of complications. The total death in this cohort is 5 patients (0.67%) (2 due to COVID-19 pneumonia and ARDS, 2 due to sepsis, and 1 due to metastasis). Smoking habits continue to be challenging in RA and lung diseases. In this population, we identified 69 smokers (18 ex-smokers), and 8 had concomitant lung disease.
Conclusion(s):
All THORAX components, including lungs, airways, pleura, and vessels, can be affected by RA. The overall rate of lung manifestation of RA in Qatar is less than that reported in other geographical areas. Patients with RA should be regularly evaluated for pulmonary disease, and, in exchange, patients with pulmonary disease of unknown etiology should always be evaluated for RA.