Pulmonary and cardiac involvement in patients with rheumatoid arthritis and ankylosing spondylitis

Year 2023, Volume: 9 Issue: 2, 291 - 300, 04.03.2023

Ahmet Hüsrev Tekeli

https://doi.org/10.18621/eurj.1108863

Abstract

Objectives: Our aim is to study the disease activity status, laboratory data and to determine the frequency of cardiac and pulmonary findings in patients with Rheumatoid arthritis (RA) and ankylosing spondylitis (AS).

Methods: Forty-five AS patients and 78 RA patients took part in the study. The C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin, creatinine, ALT, leukocyte, neutrophil ratio, hemoglobin, platelet, rheumatoid factor (RF), and anti-cyclic citrullinated peptide (anti-CCP) levels were measured. In addition, the patients' thoracic computed tomography, high-resolution computed tomography (HRCT), echocardiography (ECHO), and pulmonary function test (PFT) results were evaluated. Disease activity was assessed with the Disease Activity Score-28 (DAS-28) in RA patients, whereas the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used in patients with AS.

Results: The relationship between the anti-CCP value and gender was significant in RA patients. Significant differences were present between gender and hemoglobin value in RA and AS patients, whereas no significant differences were determined between CRP, ESR, platelet, and DAS-28 values. There was a significant difference between RF and ESR values in RA patients, whereas no significant difference was present between CRP, leukocyte, DAS-28, hemoglobin, and platelet values. Pulmonary involvement was determined in 35.7% of RA patients and 4.2% of AS patients. The difference between these was statistically significant.

Conclusions: The most common pulmonary involvement is millimetric nonspecific nodule and the most common lesion among ECHO findings was left ventricular diastolic dysfunction in RA and AS patients. In RA, no significant difference was determined between PFT and DAS-28 results, as a result, the disease activity will not directly indicate pulmonary involvement.

Keywords

Rheumatoid arthritis, ankylosing spondylitis, high-resolution computed tomography

References

• 1. Çalgüneri M. Romatoid Artrit. In: Yasavul Ü, Ed., Hacettepe İç Hastalıkları Kitabı Ankara: Prestij Basımevi; 2003: pp. 1477-95.
• 2. Lipsky PE. Rheumatoid Arthritis. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL editors. Harrison's Principles of Internal Medicine. New York: McGraw-Hill; 2005. pp. 1968-77.
• 3. Hellmann DB, Stone JH. Rheumatoid Arthritis. In: Tierney LM, McPhee SJ, Papadakis MA editors. Current Medical Diagnosis & Treatment. New York: McGraw-Hill; 2005; pp. 801-7.
• 4. Fuchs HA, Sergent SJ. Rheumatoid arthritis the clinical picture. In: Koopman WJ (ed). Arthritis and Allied conditions, 13th ed. Pennsylvania: Williams and Wilkins, 1997: pp. 1041-70.
• 5. Firestein GS. Etiology and pathogenesis of rheumatoid arthritis. In: Ruddy S, Haris ED, Sledge CB (eds). Kelley's Textbook of Rheumatology, sixth ed. Philadelphia: WB Saunders, 2001: pp. 921-1000.
• 6. Harris ED. Clinical features of rheumatoid arhritis. In: Ruddy S, Harris ED, Sledge CB (eds). Texbook of Rheumatology, 6th ed. Philadelphia: WB Saunders, 2001: pp. 967-1000.
• 7. Halla JT, Schrohenloher RE, Koopman WJ. Local Ġmmüno responses in certain extraarticular manifestations of rheumatoid arthritis. Ann Rheum Dis 1992;51:698-701.
• 8. Gray S. Romatoid Artrit. In Edward D. Harris JR, Ralph C, Clement B (ed)s. Kelley’s Textbook of Rheumatology. çeviri: Arasıl T. Kelley Romatoloji 7. baskı. Ankara: Güneş Kitabevi, 2006:996-1078.
• 9. Hamuryudan V. Romatoid artrit. Sempozyum 2007;55:69-86.
• 10. Tanoue LT. Pulmonary manifestations of rheumatoid arthritis. Clinic Chest Med 1998;19:667-85.
• 11. Holmqvist ME, Neovius M, Eriksson J, Mantel A, Wallberg-Jonsson S, Jacobsson LTH, et al. Risk of venous thromboembolism in patients with rheumatoid arthritis and association with disease duration and hospitalization. JAMA 2012; 308:1350-6.
• 12. Özgöçmen S. Tanı ve Sınıflama Kriterleri. Ankilozan spondilit ve spondiloartropatiler (çeviri), çeviri ed: Özgöçmen S. Birinci baskı. Veri medikal yayıncılık, İstanbul, 2008: pp. 24-6.
• 13. Onel D. Romatizmal Hastalıklar. Tayf Ofset, İstanbul, 1994: pp. 326-7.
• 14. Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A. Ankylosing spondylitis: an overview. Ann Rheum Dis 2002; 61 Suppl 3:iii8-18.
• 15. Niccoli L, Nannini C, Cassarà E, Kaloudi O, Cantini F. Frequency of anemia of inflammation in patients with ankylosing spondylitis requiring anti-TNFα drugs and therapy-induced changes. Int J Rheum Dis 2012;15:56-61.
• 16. Slobodin G, Naschitz JE, Zuckerman E, Zisman D, Rozenbaum M, Boulman N, et al. Aortic involvement in rheumatic diseases. Clin Exp Rheumatol 2006;24:41-7.
• 17. Eder L, Sadek M, McDonald-Blumer H, Gladman DD. Aortitis and spondyloarthritis-- an unusual presentation: case report and review of the literature. Semin Arthritis Rheum 2010;39:510-4.
• 18. Vinsonneau U, Brondex A, Mansourati J, Saraux A, Cornily JC, Arles F, et al. Cardiovascular disease in patients with spondyloarthropathies. Joint Bone Spine 2008;75:18-21.
• 19. Brunner F, Kunz A, Weber U, Kissling R. Ankylosing spondylitis and heart abnormalities: do cardiac conduction disorders, valve regurgitation and diastolic dysfunction occur more often in male patients with diagnosed ankylosing spondylitis for over 15 years than in the normal population? Clin Rheumatol 2006;25:24-9.
• 20. Boushea DK, Sundstrom WR. The pleuropulmonary manifestations of ankylosing spondylitis. Semin Arthritis Rheum 1989;18:277-81.
• 21. Kchir MM, Mtimet S, Kochbati S, Zouari R, Ayed M, Gharbi T, et al. Bronchoalveolar lavage and transbronchial biopsy in spondyloarthropathies. J Rheumatol 1992;19:913-6.
• 22. Quismorio FP Jr. Pulmonary involvement in ankylosing spondylitis. Curr Opin Pulm Med 2006;12:342-5.
• 23. Kiris A, Ozgocmen S, Kocakoc E, Ardicoglu A, Ogur E. Lung findings on high resolution CT in early ankylosing spondylitis. Eur J Radiol 2003;47:71-6.
• 24. Spoorenberg A, van der Heijde D, de Klerk E, Dougados M, de Vlam K, Mielants H, et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 1999;26:980-4.
• 25. Bostan EE, Borman P, Bodur H, Barça N. Functional disability and quality of life in patients with ankylosing spondylitis. Rheumatol Int 2003;23:121-6.
• 26. Ruof J, Stucki G. Validity aspects of erythrocyte sedimentationrate and Creactive protein in ankylosing spondylitis: a literatüre review. J Rheumatol 1999;26:966-70.
• 27. Pinheiro GC. Anti-cyclic citrullinated peptide antibodies in advanced rheumatoid arthritis. Ann Intern Med 2003;139:234-5.
• 28. Bas S, Genevay S, Meyer O and Gabay. Anti-cyclic citrullinated peptide antibodies IgM and IgA rheumatoid factors in the diagnosis and prognosis ofrheumatoid arthritis. Rheumatology (Oxford) 2003;42:677-80.
• 29. Bas S, Perneger TV, Seitz M, et al. Diagnostic tests for rheumatoid arthritis:comparision of anti-cyclic citrulinated peptide antibodies, antikeratinantibodies and IgM rheumatoid factors. Rheumatology (Oxford) 2002;41:809-14.
• 30. El Maghrauoi A, Dehhaoui M. Prevalence and characteristics of lung involvement on high resolution computed tomography in patients with ankylosing spondylitis: a systematic review. Pulm Med 2012;2012:965956.
• 31. Miller JM, Sproule BJ. Pulmonary function in ankylosing spondylitis. Am Rev Respir Dis 1964;90:376-82.
• 32. Feltius N, Hedenström H, Hillerdal G, Hallgren R. Pulmonary involvement inankylosing spondylitis. Ann Rheum Dis 1986;45:736-40.
• 33. Seçkin Ü, Bölükbası N, Gürsel G, Eröz S, Sepici V, Ekim N. Relationship between pulmonary function and exercise tolerance in patients with ankylosing spondylitis. Clin Exp Rheumatol 2000;18:503-6.
• 34. Sahin G, Çalıkoglu M, Özge C, İncel N, Biçer A, Ulsubas B, et al. Respiratory muscle strength but not BASFI score relates to diminished chest expansion in ankylosing spondylitis. Clin Rheumatol 2004;23:199-202.
• 35. Rosenow EC, Strimlan CV, Muhm JR, Ferguson RH. Pleuropulmonary manifestations of ankylosing spondylitis. Mayo Clin Proc 1977;52:641-9.
• 36. Casserly LP, Fenlon HM, Breatnach E, Sant SM. Lung findings on high resolution computed tomography in idiopathic ankylosing spondylitis-correlation with clinical findings, pulmonary function testing and plain radiography. Br JRheumatol 1997;36:677-82.
• 37. Ayhan-Ardıç FF, Oken Ö, Yorgancıoglu ZR, Üstün N, Gökharman FD. Pulmonary involvement in life long non-smoking patients with rheumatoid arthritis and ankylosing spondylitis without respiratory symptoms. Clin Rheumatol 2006;25:213-8.
• 38. Walker WC, Wright V. Pulmonary lesions and rheumatoid arthritis. Medicine 1968;47:501-20.
• 39. Horton MR. Rheumatoid arthritis associated interstitiallung disease. Crit Rev Comput Tomogr 2004;45:429-40.
• 40. Cortet B, FLipo RM, Remy-Jardin M, Coqueralla P, Duquesnoy B, Remy J, et al. Use of high resolution computed tomography of the lungs in patients with rheumatoid arthritis. Ann Rheum Dis 1995;54: 815-9.
• 41. Mc Donagh J, Greaves M, Wright AR, Heycock C, Owen JP, Kelly CA. High resolution computed tomography of the lungs in patients with rheumatoid arthritis and interstitial lung disease. Br J Rheumatol 1994;33:118-22.