Valuable indicators for detecting initial lung damage in rheumatoid arthritis

SESSION TITLE: Pulmonary Manifestations of Systemic Disease: Don't Forget About Breathing SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm PURPOSE: Rheumatoid arthritis (RA) is a chronic condition that causes systemic inflammation and pulmonary manifestations are one of the most frequently observed extra-articular complications. The goal of our study was to detect the connection between patient-reported outcome (PRO) and early lung involvement in patients with rheumatoid arthritis. METHODS: Our prospective, cross-sectional study involved a comprehensive evaluation of exposure, pulmonary function test (PF), and completion of patient-based questionnaires (EQ-5D-3L and Pittsburg sleep quality questionnaires (PSQI)) for 200 consecutive patients with RA. Every patient underwent a low-dose chest CT. RA diagnosis was established by expert rheumatologists. RESULTS: RA patients (63.2 ± 9.9 years, predominantly female (79%)) were categorized into two groups based on the presence (Group 1, N=84, age 63.2 ± 9.9, 83% women) or absence (Group 2, N=116, age 63.2 ± 9.9, 76% women) of respiratory symptoms such as cough, chest pain or dyspnea. Patients in Group 1 were characterized by a higher occurrence of smoking history, joint complaints, to those in Group 2. PFT and CO diffusion (TLCO) were significantly lower within the normal range in Group 1, including FVC (91.08±14.5 vs. 96.53±18.3, p=0.020), FEV1 (90.17±16.7 vs. 98.47±17.6, p=0.001), and TLCO (112.85±19.6 vs. 125.14±22.3, p < 0.001), compared to Group 2. Any RA associated lung involvement was observed on chest CT in 46.5 %, significantly higher in Group 1 (54.7% vs. 40.4% p=0.045). PRO was found notably inferior in Group 1 compared to Group 2 (EQ-5D-3L index value: 0.89±.0.07 vs. 0.93±0.06, p<0.001, Visual Analogue Scale 65.88±18.33 vs. 75.00± 20.1, p=0.001, PSQI: 16.40±6.66 vs.10.82±5.80, p<0.001). CONCLUSIONS: Respiratory symptoms, decreased quality of life related to mobility, reduced performance of usual activities, anxiety, as well as poor sleep quality are valuable indicators of early lung involvement in RA, also associated with functional decline in the normal range. CLINICAL IMPLICATIONS: Patients exhibiting significant respiratory symptoms and decreased PRO should be carefully selected and referred to a specialized pulmonology center for further evaluation and diagnosis of more precise respiratory manifestations of RA (including complex functional evaluation and any lung involvement including bronchial, parenchymal and pleural involvement). Regular monitoring and identification of progressive lung disease might facilitate the intensification of therapy, which may have an impact on the outcome of the disease and overall mortality. DISCLOSURES: No relevant relationships by Eniko Barczi No relevant relationships by Aniko Bohacs No relevant relationships by Noémi Eszes No relevant relationships by Kinga Fritsch No relevant relationships by Peter Horvath No relevant relationships by Nikolett Marton No relevant relationships by Pál Maurovich-Horvat No relevant relationships by Veronika Müller No relevant relationships by Tamas Nagy No relevant relationships by György Nagy No relevant relationships by Alexandra Nagy MD Consultant relationship with Chiesi Hungary kft. Please note: 2022.10.20- Added 03/31/2023 by Lőrinc Polivka, source=Web Response, value=Consulting fee No relevant relationships by Nóra Melinda Tóth No relevant relationships by Krisztina Vincze